PCM

Program Requirements

Patient Eligibility

Patients with one complex chronic condition qualify for principal care management services.

Patient Consent & Time Requirements

We obtain patient consent prior to initiating services and provide services for a minimum of 30 minutes per month to meet time requirements set forth by CMS.

Care Plan

Individual care plans are created for, and in collaboration with, the patient upon PCM enrollment. These care plans act as a comprehensive guide to the patient’s goals, health history, and behavior.

How Patients Benefit

Better Care Coordination

Patients receive regular check-ins, medication reviews, and assistance navigating their care plan—ensuring nothing slips through the cracks.

Fewer Hospitalizations

Better Care Coordination

Early intervention and consistent monitoring help identify issues before they escalate, reducing avoidable hospital stays and emergency visits.

Personalized Care Plans

Better Care Coordination

Personalized Care Plans

Each patient’s care is tailored to their unique needs and updated regularly, with our care team reaching out to offer timely support and education.

Proactive Outreach

Better Care Coordination

Personalized Care Plans

Patients no longer feel alone in managing their health—they have a dedicated team they can rely on, fostering trust and better self-management.

Expected Reimbursement

$61.78*

First 30 minutes of clinical staff time directed by the physician or other qualified health care professional per calendar month, for the management of one complex chronic condition expected to last at least 3 months and that places the Patient at significant risk of hospitalization, acute exacerbation, functional decline, decompensation, or death. Includes development, monitoring, or revision of a disease-specific care plan and ongoing communication and care coordination between relevant practitioners.

$50.46*

Additional 30 minutes of clinical staff time directed by the physician or other qualified health care professional per calendar month, for the management of one complex chronic condition expected to last at least 3 months and that places the Patient at significant risk of hospitalization, acute exacerbation, functional decline, decompensation, or death. Includes development, monitoring, or revision of a disease-specific care plan and ongoing communication and care coordination between relevant practitioners.

Note: Rates may vary by region. Average reimbursement for Southern California region, per MPFS Lookup.

Principal Care Management (PCM)

What is principal care management?

Program Requirements

Patient Eligibility

Patient Consent & Time Requirements

Care Plan

How Patients Benefit

Better Care Coordination

Better Care Coordination

Better Care Coordination

Fewer Hospitalizations

Better Care Coordination

Better Care Coordination

Personalized Care Plans

Better Care Coordination

Personalized Care Plans

Proactive Outreach

Better Care Coordination

Personalized Care Plans

Expected Reimbursement

$61.78*

$50.46*

Principal Care Management (PCM)

What is principal care management?

Program Requirements

Patient Eligibility

Patient Consent & Time Requirements

Care Plan

How Patients Benefit

Better Care Coordination

Better Care Coordination

Better Care Coordination

Fewer Hospitalizations

Better Care Coordination

Better Care Coordination

Personalized Care Plans

Better Care Coordination

Personalized Care Plans

Proactive Outreach

Better Care Coordination

Personalized Care Plans

Expected Reimbursement

$61.78*

$50.46*

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