Resources for care teams
By MySeema · Published November 10, 2026
A plain guide to PCM for physician practices, ACOs, and health systems: what it is, who qualifies, the codes, and what must be in place before you start.
Principal Care Management (PCM) is a Medicare care-management service focused on one serious, complex chronic condition expected to last at least three months, managed under a disease-specific care plan.
The PCM codes are 99426, 99427, 99424 and 99425.
| Code | Covers | 2026 national office benchmark |
|---|---|---|
| 99426 | Clinical staff: First 30 minutes / month | $67.80 / patient month |
| 99427 | Clinical staff: Each additional 30 minutes | $54.11 / additional 30 min |
| 99424 | Clinician personally: First 30 minutes / month | $87.51 / patient month |
| 99425 | Clinician personally: Each additional 30 minutes | $61.46 / additional 30 min |
One qualifying high-risk condition and a disease-specific care plan. Staff and practitioner-personal pathways are distinct; do not count the same work twice.
2026 Medicare allowed amounts, national office/nonfacility benchmark, non-QP conversion factor. Includes applicable patient cost sharing; before practice costs and MySeema fees. Actual collections vary with location, setting, clinician, coverage, and claim adjustments. See the rate source and estimate your practice.
Patient cost sharing and protections depend on coverage and the service. Explain them before consent. RHC/FQHC payment rules and Medicare Advantage contracts differ from the national benchmark.
Your clinicians keep clinical decisions and oversight, and your organization bills eligible services.
The benchmarks on this page are 2026 amounts. Medicare’s 2027 conversion factor is lower ($32.63 for most clinicians, down 2.31%), so 2027 payment amounts will differ. Read what the 2027 fee schedule changes.
PCM focuses on one complex, high-risk chronic condition and its disease-specific care plan. CCM is built around two or more chronic conditions and a broader comprehensive care plan.
PCM may be furnished by the practitioner responsible for the principal condition when all requirements are met. The correct clinical owner depends on the patient's care and the applicable rules, not on a marketing label.
The same work or time cannot be counted twice. The billing organization should review concurrent-service rules and choose the service that matches what was actually furnished.
This guide summarizes Medicare requirements for planning. It is not a billing manual or a promise of reimbursement. Confirm requirements with your billing and compliance teams.
Discuss the population and workflow you want to support, the responsibilities your team would retain, and the next steps for a proposed scope.