By Pallav Mehta, MD, Reimagine Care Medical Director
Cancer care is often compared to an iceberg – the exam room is just the tip. Beneath the surface lies a mountain of hidden effort: logjammed care coordination, symptom management, emotional support, and follow-up. PCM (Principal Care Management), as I recently described in an article for AJMC, offers a way to bring that behind-the-scenes work into view – and reimbursement. It allows oncology practices to bill for time spent managing high-risk patients beyond face-to-face visits, but adoption remains limited.
What Makes PCM a Game-Changer, and Yet So Underused
PCM provides four CPT codes that let providers bill for care coordination when managing a single high-risk condition such as cancer – once a minimum of 30 minutes is documented monthly, with add-ons for additional time. These services might include outreach after treatment cycles, medication reviews, telehealth follow-ups, or overseeing transitions across settings. Yet practices consistently cite operational complexity, documentation burdens, low awareness, and unclear workflows as barriers to adoption. Indeed, data from earlier care models like CCM show uptake rates as low as 2-7% among eligible providers. Without organizational readiness or infrastructure to support these new codes, PCM’s promise remains largely untapped.
Importantly, PCM reimbursement rates can range from approximately $48 to $83 per patient per month, depending on the provider type and time documented. For instance, CPT 99424 and 99425 reimburse around $83.40 for the first and additional 30 minutes of physician or qualified professional time per month, while CPT 99426 and 99427 reimburse around $48.45 for clinical staff time under supervision. These are significant sums that can cover the costs of dedicated care team members, but they require precise documentation, appropriate patient consent, and clear alignment with disease-specific care plans.
Tech + Workflow: The Keys to Realizing PCM’s Value
The shift to value-based oncology care models has underscored the need for tools that support patient-centered coordination, and that’s where digital innovation comes in. EHR-integrated identification and enrollment tools, AI-assistance for documentation, automated routing to care plans, and pre-billing validation can dramatically lower the burden of PCM implementation. When combined with analytics that track outcomes like emergency visits, patient satisfaction, and staff effort, PCM stops being just a billing add-on and becomes a catalyst for better care and sustainability.
How Reimagine Care Bridges the Gap
That’s exactly what Reimagine Care enables. Through our virtual care model, we extend oncology teams with AI-powered symptom management, digital check-ins, and 24/7 on-demand access to clinical oncology staff – all integrated seamlessly with in-clinic workflows. Our Remi virtual assistant probes symptoms via SMS, triages needs according to evidence-based pathways, and escalates to our Virtual Care Center when human intervention is needed.
This infrastructure supports PCM implementation by:
- Identifying eligible patients early and dynamically – via risk-stratification and symptom tracking that aligns with PCM requirements.
- Capturing activity automatically, since Remi and the care team log contact time, interventions, and escalations – all mapped to care plans and suitable for billing.
- Reducing documentation burden, because notes are auto-generated, mapped to PCM rules, and audit-ready.
- Providing real-time visibility, with dashboards that monitor how much PCM time is logged vs. reimbursed, emergency utilization, patient-reported outcomes, and staffing metrics.
- Supporting clinician well-being, since Reimagine resolves over 90% of patient symptom issues virtually, drastically cutting interruptions and non-critical demands on in-clinic teams.
The Bottom Line
PCM holds tremendous potential for rewarding the invisible labor of oncology coordination, aligning financial and clinical incentives, and improving outcomes. But without smart, integrated tools, it remains a theoretical opportunity.
Reimagine Care makes PCM practical and impactful by wrapping virtual support, AI intelligence, and seamless workflows around oncology practices. The result? Better patient access, fewer emergency visits, more direct time for providers, and a financially sustainable model for care coordination – one documented minute at a time.
To discuss and find out more, please reach out to Sales@reimaginecare.com or visit our PCM Code Guide.