2025 Reimbursement Rates & Oncology Applications
At Reimagine Care, we believe oncology practices should be empowered with every tool available to improve patient outcomes and practice sustainability. Principal Care Management (PCM) represents a significant opportunity for cancer specialists to be reimbursed for the critical care coordination and patient support they already provide every day. Our Medical Director, Dr. Pallav Mehta, recently authored a byline on this very topic, underscoring its potential to transform oncology care delivery. This guide outlines the latest 2025 PCM codes, reimbursement rates, and oncology-specific applications—helping practices streamline billing, enhance patient engagement, and drive measurable improvements in care.
PCM Overview
Principal Care Management (PCM) is a Medicare-reimbursed program designed for patients with a single, high-risk chronic condition that requires ongoing care coordination. Introduced in 2020, PCM enables specialists like oncologists to deliver disease-specific care management services between visits.
PCM codes are part of the broader CPT code family 99421–99429, which encompasses preventive medicine and care management services. Within this range, 99424–99427 are specifically designated for PCM. These are the codes most relevant to oncology practices and the focus of this article.
Key Requirement: Minimum 30 minutes of care management time per calendar month per patient
Official Descriptor (per CPT):
Principal care management services, first 30 minutes of physician or other qualified health care professional time, per calendar month.
Requirements & Services:
- Physician/QHP personally provides services
- Disease-specific care plan development
- 30+ minutes of service time per month
- Remote patient monitoring integration
- Care coordination with specialists
Official Descriptor (per CPT):
Each additional 30 minutes of physician or other qualified health care professional time, per calendar month (List separately in addition to code for primary procedure).
Requirements & Services:
- Ongoing care plan adjustments
- Reinforcing treatment adherence
- Additional documentation of services
Official Descriptor (per CPT):
Principal care management services, first 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Requirements & Services:
- Clinical staff provides services under supervision
- RNs, care coordinators, pharmacists eligible
- “Incident to” physician services
- Patient symptom monitoring
- Medication adherence support
Official Descriptor (per CPT):
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).
Requirements & Services:
- Additional 30-minute increments by staff
- Enhanced patient communication
- Care plan implementation support
- Treatment adherence monitoring
- Coordination with care team
PCM in Oncology Practice
PCM is particularly valuable for oncology practices as cancer represents a single, complex chronic condition requiring intensive care coordination. Oncologists can now bill for care management services without needing to identify a second comorbidity (unlike CCM services).
Cancer Care Coordination
- Chemotherapy regimen monitoring
- Radiation therapy follow-up
- Multi-disciplinary team coordination
- Treatment plan adjustments
Remote Patient Monitoring
- Symptom tracking between visits
- Medication adherence monitoring
- Side effect management
- Early intervention alerts
Navigation Services
- Treatment navigation support
- Resource coordination
- Social determinants of health
- Patient advocacy and education
Quality Outcomes
- Reduced hospitalizations
- Improved treatment compliance
- Enhanced patient engagement
- Better care continuity
PCM vs. Other Care Management Services
| Service Type | Conditions Required | Time Requirement | Provider Type | Key Focus |
| PCM | 1 complex chronic condition | 30+ minutes/month | Physician/QHP or Clinical Staff | Disease-specific management |
| CCM | 2+ chronic conditions | 20+ minutes/month | Physician/QHP or Clinical Staff | Multi-condition coordination |
| APCM | Primary care patients | Bundle approach | Primary care providers only | Comprehensive primary care |
Comprehensive primary care
Generate significant monthly recurring revenue through structured care management billing, with average reimbursements ranging from $48-83 per patient per month.
Quality Metrics
Improve value-based care metrics including patient engagement scores, treatment adherence rates, and reduced emergency department utilization.
Specialty Focus
Enables oncologists and other specialists to provide reimbursed care management for their area of expertise without requiring additional conditions.
Compliance & Billing Considerations
- PCM requires at least 30 minutes of services per calendar month.
- PCM and CCM cannot be billed in the same month for the same patient.
- Medicare guidance specifies that providers must document patient consent (written or verbal) and maintain evidence of time spent to support billing.
- As of January 2025, Rural Health Clinics and Federally Qualified Health Centers can bill these codes individually.
- Rates are based on the 2025 Medicare Physician Fee Schedule and may vary by geography.