Principal Care Management (PCM) Services

230.2.2– Principal Care Management (PCM) Services (Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23) Effective January 1, 2021, RHCs and FQHCs are paid for PCM services when a minimum of 30 minutes of qualifying PCM services are furnished during a calendar month. PCM services may be furnished to patients with a single high- risk or complex condition that is expected to last at least 3 months and may have led to a recent hospitalization, and/or placed the patient at significant risk of death. PCM service requirements include: • A single complex chronic condition lasting at least 3 months, which is the focus of the care plan; • The condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization; • The condition requires development or revision of disease-specific care plan; • The condition requires frequent adjustments in the medication regiment; and • The condition is unusually complex due to comorbidities.