Confirm the principal condition
We agree the qualifying diagnoses and the specialist or primary team that owns the plan.
Chronic & complex carePCM
PCM is built for patients whose care centres on a single complex condition — often managed by a specialist. We keep the condition-specific plan moving: outreach, medication follow-up, appointment coordination and documentation tied to that one diagnosis.
Who qualifies
Eligibility is confirmed against your own population before a pilot group is approached.
- 01
One complex chronic condition expected to last at least three months
- 02
The condition placed the patient at significant risk of hospitalization, decline or death
- 03
The condition requires development, monitoring or revision of a disease-specific care plan
- 04
Consent documented before services begin
What your patients experience
- Support focused on the condition that matters most
- Fewer gaps between specialist visits
- Help understanding medication changes
- A coordinator who knows their plan
How we run it
Your clinicians keep every clinical decision. We run the operations around them.
Enroll and set the plan
Consent is captured and the disease-specific care plan is shared with the patient.
Condition-focused follow-up
Medication, symptom and appointment follow-up stays tied to the principal condition.
Route changes fast
Worsening symptoms or missed treatments go straight to the responsible clinician.
Document and hand off
Time and activities are logged for sign-off at the end of each month.
Stays with your clinicians
Diagnosis, treatment decisions and plan revisions remain with the treating physician or QHP.
What your practice receives
- Specialist-friendly workflows
- Condition-specific care-plan tracking
- Time logs by staff type
- Monthly summaries ready for review
Billing reference
Listed as published for calendar year 2026 under the Medicare Physician Fee Schedule. Requirements, documentation rules and payer policies change — confirm current CMS and payer guidance with your billing team. Carevory does not guarantee reimbursement. PCM billing codes
| Code | What it covers |
|---|---|
| 99424 | First 30 minutes by a physician or QHP, per calendar month |
| 99425 | Each additional 30 minutes by a physician or QHP |
| 99426 | First 30 minutes of clinical staff time |
| 99427 | Each additional 30 minutes of clinical staff time |
Carevory does not guarantee reimbursement. Confirm current CMS and payer guidance with your billing team before you bill.
Often combined with
The same minutes are never counted toward two programs — time is logged against one at a time.
FAQ
What practices ask before launching PCM.
When one condition drives most of the patient's care, especially under a specialist. Patients with several significant conditions are usually a better fit for CCM.
Yes. PCM is frequently run by specialty practices such as cardiology, nephrology and oncology.
Your clinicians, or qualified clinical staff working under your supervision and protocols where contracted. Carevory runs the operations around them: eligibility, enrollment, outreach, scheduling, queues, documentation and reporting.
No. Payer rules, documentation and clinical decisions determine payment. We help you meet program requirements and give you clean records for billing review.
Start with one workflow
Tell us about your patient population, systems and staffing. We'll scope a pilot group, the workflow and the reporting you'd see each month.
Business inquiries only. Please don't include patient information.