The new PCM codes, which became effective Jan. These codes may be used for allergists treating patients with severe, uncontrolled asthma who meet the required criteria outlined below. This includes the extra time and work required for medication adjustments, creating a care plan, patient follow-up and more.

The four new PCM codes are intended to reimburse physicians for the additional work they do caring for high risk, complex patients. PCM codes are intended to cover services for patients with only one complex chronic condition that requires management by a specialist. CMS’ goal is to improve care for these complicated patients and keep them out of the hospital, and it is willing to pay physicians more to make that happen. This is a win-win for both allergists and patients. These codes may be an additional revenue opportunity for allergists caring for patients with severe, high-risk asthma who meet required criteria as they will add monthly payments above existing E/M codes.

In the Medicare Physician Fee Schedule final rule issued last November, the Centers for Medicare and Medicaid Services (CMS) added four new CPT codes in the category of Principal Care Management (PCM) to replace the two previous PCM codes (HCPCS codes G2064 and G2065). Policy on Cooperative Programs With Industry.

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