Updated for 2026. Principal Care Management (PCM) and Chronic Care Management (CCM) are both Medicare care-management services, but they are designed for different types of patients.
The simplest distinction is that PCM focuses on one complex, high-risk chronic condition, while CCM is designed for patients with two or more chronic conditions.
Understanding the difference can help practices choose the appropriate care-management workflow, documentation structure, and CPT code for each patient.
PCM vs CCM at a Glance
FeaturePCMCCMFull namePrincipal Care ManagementChronic Care ManagementPrimary focusOne complex, high-risk chronic conditionTwo or more chronic conditionsExpected durationGenerally at least 3 monthsAt least 12 months or until deathCare planDisease-specific care planComprehensive patient-centered care planPractitioner codes99424, 9942599491, 99437Clinical staff codes99426, 9942799490, 99439Complex CCM codesNot applicable99487, 99489
What Is Principal Care Management?
Principal Care Management is a Medicare care-management service intended for a patient with a single high-risk, complex chronic condition that requires focused ongoing management.
CMS describes PCM as disease-specific care management for a condition that places the patient at significant risk of hospitalization, death, acute exacerbation or decompensation, or functional decline.
The condition generally requires ongoing clinical attention, a disease-specific care plan, and frequent medication adjustment or unusually complex management because of the patient's circumstances or comorbidities.
Who May Qualify for PCM?
A PCM patient generally has one complex chronic condition that:
- Is expected to last at least 3 months
- Places the patient at significant risk of hospitalization
- May create risk of death, acute exacerbation, decompensation, or functional decline
- Requires a disease-specific care plan
- Requires ongoing communication and coordination among relevant practitioners
- May require frequent medication adjustments
- May involve management that is unusually complex because of comorbidities
Eligibility should always be based on the individual patient's documented clinical circumstances rather than diagnosis alone.
Examples of Patients Who May Need PCM
PCM may be relevant when one condition is driving a significant portion of the patient's ongoing management.
Examples might include a patient receiving intensive management for:
- Complex heart failure
- Chronic kidney disease
- Severe COPD
- Complex diabetes management
- Cancer requiring ongoing disease-specific coordination
- Another high-risk chronic condition meeting Medicare requirements
A diagnosis itself does not automatically establish PCM eligibility. The complexity and ongoing care-management requirements should be supported in the medical record.
What Is Chronic Care Management?
Medicare CCM is designed for patients with two or more chronic conditions expected to last at least 12 months, or until the patient's death.
CMS states that these conditions must place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
CCM takes a broader approach than PCM because the care team manages the interaction of multiple chronic conditions through a comprehensive patient-centered care plan.
PCM Focuses on One Condition; CCM Looks Across Multiple Conditions
This is the most important operational difference between the two programs.
PCM Example
A patient has advanced chronic kidney disease that requires intensive nephrology management, repeated medication adjustments, disease-specific education, and ongoing coordination. The kidney disease is the primary condition driving the management service.
If Medicare's other requirements are satisfied, the practitioner may evaluate whether PCM is appropriate.
CCM Example
A patient has diabetes, hypertension, COPD, and osteoarthritis. The practice manages medication adherence, specialist coordination, treatment goals, functional needs, and interactions between multiple conditions.
That broader care-management relationship may be more consistent with CCM.
PCM CPT Codes for 2026
CPT CodeWho Provides the ServiceTime99424Physician or other qualified healthcare professional personallyFirst 30 minutes per calendar month99425Physician or other qualified healthcare professional personallyEach additional 30 minutes99426Clinical staff directed by physician or other qualified healthcare professionalFirst 30 minutes per calendar month99427Clinical staff directed by physician or other qualified healthcare professionalEach additional 30 minutes
CMS continues to identify CPT 99424, 99425, 99426, and 99427 as Principal Care Management services.
CCM CPT Codes for 2026
CPT CodeWho Provides the ServiceTime99490Clinical staffFirst 20 minutes99439Clinical staffEach additional 20 minutes99491Physician or qualified healthcare professional personallyFirst 30 minutes99437Physician or qualified healthcare professional personallyEach additional 30 minutes99487Clinical staff for complex CCMFirst 60 minutes99489Clinical staff for complex CCMEach additional 30 minutes
PCM Care Plan vs CCM Care Plan
Both programs rely on structured care planning, but the scope differs.
PCM Disease-Specific Care Plan
CMS describes PCM as requiring a disease-specific care plan centered on the patient's principal high-risk condition.
The plan may address:
- Disease-specific treatment goals
- Medication management
- Symptoms and warning signs
- Specialist involvement
- Patient education
- Coordination among practitioners
- Follow-up and monitoring requirements
CCM Comprehensive Care Plan
A CCM care plan is broader and may address:
- Multiple chronic conditions
- Medication management
- Measurable treatment goals
- Functional status
- Cognitive needs
- Psychosocial needs
- Environmental barriers
- Caregiver support
- Specialist coordination
- Community resources
- Care transitions
Can a Specialist Provide PCM?
Yes. PCM is particularly relevant to specialty care because it allows focused management of a single complex disease.
For example, PCM might be furnished by an appropriate specialist managing a patient's principal condition while a primary care practitioner coordinates other aspects of the patient's health.
The practitioner must still satisfy Medicare requirements and ensure the service is medically necessary and properly documented.
Can PCM and CCM Be Billed in the Same Month?
Potentially, but not by the same practitioner for the same patient in the same month.
CMS states that CCM and PCM cannot be billed by the same practitioner for the same patient during the same month.
However, CMS allows a primary care practitioner and a specialist to provide CCM and PCM concurrently when appropriate.
The conditions being addressed by the two services must be different.
Example
A primary care practitioner manages a patient's diabetes, hypertension, and COPD through CCM.
A cardiologist separately provides disease-specific PCM for a complex cardiac condition.
When all Medicare requirements are met, CMS allows the separate practitioners to provide the services during the same period, provided the conditions being addressed are different.
Two Separate Care Plans May Be Required
CMS states that when PCM and CCM are furnished concurrently, two care plans are required.
The CCM practitioner maintains the comprehensive care plan covering the patient's multiple chronic conditions.
The PCM practitioner maintains a separate disease-specific care plan for the principal condition being managed.
Avoid Duplicate Time and Duplicate Work
Practices should not use the same care-management activity or minutes to support multiple services when duplicate reporting is not permitted.
If multiple practitioners are managing the same patient, documentation should make clear:
- Which condition each practitioner is managing
- Which activities belong to PCM
- Which activities belong to CCM
- Who performed each activity
- How much qualifying time was spent
- How the two care plans differ
PCM vs CCM Example
Patient SituationProgram to EvaluateOne complex heart-failure condition requiring focused specialist managementPCMDiabetes + hypertension + COPD requiring coordinated longitudinal managementCCMOne complex kidney condition requiring frequent medication adjustmentPCMMultiple interacting chronic diseases plus medication and specialist coordinationCCM
These examples are illustrative only. Actual eligibility depends on Medicare requirements and the patient's documented clinical situation.
PCM and Advanced Primary Care Management
Practices should also be aware of Advanced Primary Care Management (APCM).
CMS describes APCM as a monthly bundled primary-care service that incorporates elements of several existing services, including PCM, CCM, Transitional Care Management, virtual check-ins, and other communication-based services.
Unlike traditional PCM and CCM codes, APCM is structured as a monthly bundle and does not use the same minute-by-minute thresholds.
Practices using APCM should review current CMS bundling and billing rules before separately reporting overlapping care-management services.
Which Program Fits the Patient?
A practice should not choose between PCM and CCM based only on reimbursement or the easiest time threshold.
Instead, ask:
- Is one complex chronic condition driving the majority of ongoing management?
- Does the patient have two or more chronic conditions requiring comprehensive management?
- How long are the conditions expected to persist?
- What is the patient's risk of hospitalization or functional decline?
- Does the patient need a disease-specific or comprehensive care plan?
- Which practitioner is responsible for each condition?
- Are other practitioners already billing care-management services?
PCM Documentation Checklist
- Identify the single principal complex chronic condition.
- Document the expected duration of the condition.
- Document the patient's clinical risk.
- Support the need for complex disease-specific management.
- Create and maintain a disease-specific care plan.
- Document medication-management needs.
- Document communication and care coordination.
- Identify who performed each service.
- Track qualifying monthly time.
- Select the CPT code that matches the practitioner or clinical-staff workflow.
CCM Documentation Checklist
- Document at least two qualifying chronic conditions.
- Support the expected 12-month duration or until death.
- Document relevant clinical risk.
- Obtain and document required consent.
- Complete an initiating visit when required.
- Create a comprehensive patient-centered care plan.
- Document qualifying monthly activities.
- Track staff and practitioner time accurately.
- Document care coordination and care transitions.
- Verify that the reported code matches the services furnished.
How ChronicSync Can Help
Practices managing PCM, CCM, RPM, and other care-management programs need clear separation between patient programs, care plans, staff activity, and monthly documentation.
ChronicSync helps care teams organize chronic-care workflows, maintain structured documentation, track ongoing patient activity, and improve operational visibility across care-management programs.
Start your ChronicSync Free Pilot and explore a more organized approach to chronic care management.
Frequently Asked Questions
What is the main difference between PCM and CCM?
PCM focuses on management of one complex, high-risk chronic condition. CCM is designed for patients with two or more qualifying chronic conditions requiring broader comprehensive care management.
How many conditions are required for PCM?
PCM focuses on a single complex chronic condition that meets the applicable Medicare requirements.
How many chronic conditions are required for CCM?
Medicare CCM requires two or more chronic conditions expected to last at least 12 months or until the patient's death and that create the required clinical risk.
What are the PCM CPT codes?
The current PCM codes are CPT 99424 and 99425 for services personally provided by a physician or other qualified healthcare professional, and CPT 99426 and 99427 for qualifying clinical-staff services directed by the practitioner.
How much time is required for PCM?
The base PCM codes 99424 and 99426 represent the first 30 minutes per calendar month. CPT 99425 and 99427 represent additional 30-minute periods for their respective service types.
Can PCM and CCM be billed together?
CMS states that the same practitioner cannot bill PCM and CCM for the same patient in the same month. However, different practitioners may provide the services concurrently when appropriate, the conditions being addressed are different, and the applicable requirements are satisfied.
Do PCM and CCM require the same care plan?
No. PCM uses a disease-specific care plan. CCM requires a broader comprehensive care plan. CMS states that if PCM and CCM are provided concurrently, two care plans are required.
Sources
- CMS: Advanced Primary Care Management Services
- CMS: Chronic Care Management Frequently Asked Questions
- CMS: Chronic Care Management for Complex Conditions
This article is provided for educational purposes only and does not constitute medical, legal, coding, reimbursement, or billing advice. Medicare, CPT, MAC, and commercial-payer requirements can change. Verify current requirements before submitting claims.