US · guidance
CMS Pub. 100-02, ch. 13, § 230.2.2
Principal Care Management (PCM) Services
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.
History
(Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d81ecafdaae6bfb78f7cffd93765f5c93cf3b1a2c767d4e03eb8e31cf13cba6c
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