What is PCM?

Medicare has initiated a new program where they started paying separately for patients suffering with a single high-risk chronic condition. Patients who give their consent for PCM program have a ‘Care Plan’ built for them with tasks and goals to keep a check on patient’s health and related disease. The provider checks up on the patient over phone calls and bills for that month’s service according to the payment schedule.

PCM is typically a telephonic service provided to patients with a single chronic condition expected to last at least 3-12 months or until the death of patient. Main focus of this service is advanced primary care such as;

• A continuous relationship with a designated member of the care team
• Patient support for chronic diseases to achieve health goals
• 24/7 patient access to care and health information
• Patient and caregiver engagement
• Timely sharing and use of health information.

To see how to add diagnosis for a patient, click here.

Insurance plans need to be added from the ‘Settings’ module for patients using a specific plan. To understand the workflow for adding an insurance plan, click here.

CPT codes:

• G2064
• G2065

These codes are used to bill at least 30 minutes of physician, other qualified health care professional or clinical staff time.