What is Principal Care Management, anyway?

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Designed to be billed by specialists who are focused on managing patients with a single complex chronic condition requiring substantial care management

The requirements for PCM codes are very specific and easily audited.

 

Allergists billing PCM codes need to carefully document that patients meet the specified criteria.

 

The disease-specific care plan should be included in the patient’s chart, along with documentation of medication adjustments, patient communications, etc.

 

Finally, allergy practices should document the amount of time spent providing care each month.

Patients covered by PCM codes must meet the following CMS criteria:

 

• They have one complex chronic condition lasting at least three months.

• The condition is severe enough that the patient is at risk for hospitalization or was recently hospitalized due to the condition.

• The condition requires development or revision of a disease-specific care plan.

• The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.

 

The Food Allergy Fix App helps you meet the criteria to qualify for Principal Care Management reimbursement.