Your Guide to Principal Care Management
Watch this presentation to learn how to effectively utilize principal care management in your food allergy practice. Dr. Sakina Bajowala, the developer of the Food Allergy Fix Mobile App & Web Portal, is a nationally recognized expert on virtual care services in allergy.
What is Principal Care Management, anyway?
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.
Neither private payers nor Medicaid are obligated to pay these codes. Please check with the payer or state Medicaid program to verify coverage. WisePrince Holdings, LLC makes no guarantee that purchase/use of the Food Allergy Fix App will ensure reimbursement for services.