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The Difference Between PCM, CCM, and APCM: What Providers Need to Know

Managing chronic conditions is a growing priority for healthcare providers, but not all care management programs are designed with the same purpose in mind. Principal Care Management (PCM), a relatively new program introduced in 2020, reimburses practices and specialists for managing patients with a single chronic condition.

Unlike programs that address multiple conditions at once, PCM allows providers to zero in on one health issue, helping patients receive more targeted support while preventing additional conditions from developing.

Because every patient population is different, not every care management model fits every need. While Chronic Care Management (CCM) aims to coordinate care for patients with multiple chronic conditions, Advanced Primary Care Management (APCM), launched in 2025, focuses on preventive health management and early interventions that can improve outcomes, even for patients without chronic conditions. On the other hand, PCM is built for patients who need focused management for one ongoing health concern.

Understanding these differences can help your practice allocate resources where they’ll have the greatest impact. Choosing the right care management program ensures that your practice delivers the most appropriate support, meets patients where they are in their health journey, and maximizes both clinical outcomes and reimbursement opportunities.

What is Principal Care Management (PCM)?

Principal Care Management (PCM) is a care management program designed for patients with a single high-risk chronic condition that is expected to last at least three months. Its purpose is to provide focused, comprehensive support for managing that one condition effectively, helping patients avoid complications and maintain stability.

PCM services typically include:

The creation of a personalized care plan outlining treatment goals, planned interventions, and follow-up schedules
Regular patient check-ins, either in person or remotely
Coordination with other providers involved in the patient’s care
Education for both patients and caregivers

By offering structured, ongoing oversight, PCM enables providers to deliver consistent, proactive care for patients who need close attention for one specific condition.

PCM vs. Chronic Care Management (CCM)

While Principal Care Management and Chronic Care Management (CCM) are both designed to support patients with chronic health issues, they differ in scope and intended use.

PCM focuses on a single chronic condition that requires close monitoring and proactive care. It is often used as an early intervention for patients who have one significant health concern, such as heart failure or cancer, where dedicated oversight can prevent complications or the development of additional conditions.

CCM, in contrast, is designed for patients managing two or more chronic conditions expected to last at least 12 months. Its broader approach allows providers to coordinate care across multiple conditions and often multiple specialists. This program emphasizes comprehensive care planning, medication management, and ensuring patients stay on track with all recommended treatments and follow-ups.

For practices, one of the most practical differences is the eligibility threshold. A patient with just one qualifying condition cannot be enrolled in CCM; they must have at least two. Conversely, if a patient enrolled in PCM later develops an additional chronic condition, they may become eligible to transition into CCM for more expansive management.

The time requirements also vary slightly: PCM typically requires at least 30 minutes of care management activities per month, while CCM requires 20 minutes for non-complex care or more for complex cases. These distinctions make PCM an ideal starting point for patients who need dedicated management for one significant health issue, while CCM offers more comprehensive support for those managing multiple ongoing conditions.

PCM vs. Advanced Primary Care Management (APCM)

While PCM and CCM are both designed for patients with chronic conditions, Advanced Primary Care Management (APCM) has a broader objective.

APCM emphasizes preventive care, early intervention, and risk management, while supporting patients with or without chronic illnesses—instead of focusing solely on managing existing conditions.

Compared to PCM, APCM takes a more comprehensive approach. It includes services such as health assessments, routine screenings, and targeted outreach to engage patients before they develop high-risk conditions. For patients who already have chronic illnesses, APCM can help them stay on track with recommended care while also identifying opportunities to improve long-term outcomes.

APCM often complements programs like PCM. Where PCM is used to deliver concentrated care for one high-risk condition, APCM can create a broader foundation of patient engagement—one that helps patients stay connected to their care, improves practices’ quality metrics, and helps providers reach rising-risk patients before their needs become more complex.

Another key difference is the reporting requirements. APCM incorporates quality measurement as a core element, meaning your practice must track and report certain metrics to maintain compliance. If you are an FQHC, an RHC, or a member of an ACO or AAPM, that will fulfill your reporting requirements for APCM. If you are in traditional MIPS, you must switch to the Value in Primary Care MIPS Value Pathway. PCM, however, has no quality reporting requirement, making it simpler to launch for practices that want to start with a more narrowly focused program.

Key differences between PCM, CCM, and APCM

To choose the right care management program for your practice, you first need to understand the practical differences that affect your patients, your team’s workflow, and your bottom line. From eligibility and time requirements to billing codes and reimbursement rates, each model comes with its own expectations and opportunities.

The chart below provides a quick look at key differences, followed by a closer look at what these distinctions really mean in practice.

	Principal Care Management	Chronic Care Management	Advanced Primary Care Management
Focus	Management of a single high-risk condition	Provision of comprehensive, coordinated care to improve overall health	Proactive, preventive health management to improve outcomes
Time requirements	30 minutes of care management	20 minutes of care management	No time requirements
Eligibility	Medicare patients with one chronic condition expected to last 3+ months	Medicare patients with two or more chronic conditions expected to last 12+ months	All Medicare patients, stratified by number of conditions and QMB status
Billing codes and reimbursement*	99424: $80.87 per patient, per month 99425: $58.87 per patient, per month 99426: $61.78 per patient, per month 99427: $50.46 per patient, per month	99490: $60.49 per patient, per month 99439: $45.93 per patient, per month 99491: $82.16 per patient, per month 99437: $57.58 per patient, per month	G0556: $15 per patient, per month G0557: $50 per patient, per month G0558: $110 per patient, per month
Quality measurement	Not required	Not required	Required

*Reimbursement rates are based on national averages and will vary depending on your practice's location.

Focus

Each program is designed to address different patient needs.

Principal Care Management (PCM) supports patients with a single chronic condition that requires ongoing attention, allowing providers to concentrate on managing that one condition effectively.
Chronic Care Management (CCM) is structured for patients with two or more chronic conditions, coordinating their care to help prevent complications and improve overall health.
Advanced Primary Care Management (APCM) has a broader scope: it not only supports patients with chronic conditions but also emphasizes proactive, preventive care to help patients avoid developing more serious health issues in the first place.

Time requirements

The amount of care management time required each month varies and can influence how you staff and plan your workflows.

PCM requires at least 30 minutes of care management activities per patient, per month—enough time to create and adjust care plans, follow up, and coordinate with other providers as needed.
CCM is slightly less intensive, requiring 20 minutes of qualifying services.
APCM, on the other hand, doesn’t impose specific time requirements, allowing your team to tailor their outreach and follow-up based on risk stratification rather than a minimum threshold.

Eligibility

Not every patient qualifies for every program, and understanding eligibility helps you match patients to the right level of support.

PCM is for patients with a single chronic condition expected to last at least three months—often those whose primary issue is severe enough to warrant focused care but not so complex that multiple conditions need managing at once.
CCM is intended for patients with two or more chronic conditions expected to persist for at least a year, making it well-suited for individuals with overlapping health challenges that impact their daily lives.
APCM casts the widest net: it’s open to all Medicare patients, with stratification based on the number of conditions and their Qualified Medicare Beneficiary (QMB) status.

Billing codes and reimbursement

Billing codes for these programs correspond to the intensity and type of care provided each month.

PCM:

99424 – Initial 30 minutes of care management by a physician or qualified health professional (QHP)
99425 – Each additional 30 minutes provided by a physician or QHP
99426 – Initial 30 minutes of clinical staff time
99427 – Each additional 30 minutes of clinical staff time

Reimbursement ranges from about $50 to $80 per patient, per month depending on time spent and who performs the care.

CCM:

99490 – Initial 20 minutes of clinical staff time
99439 – Each additional 20 minutes of clinical staff time
99491 – Initial 30 minutes of care provided by a physician or QHP
99437 – Each additional 30 minutes of care provided by a physician or QHP

Reimbursement ranges from about $45 to $82 per patient, per month depending on time spent and who performs the care.

Learn more: Chronic Care Management CPT Codes & Billing Guide

APCM:

G0556 – Patients with one or fewer chronic conditions
G0557 – Patients with two or more chronic conditions
G0558 – QMBs with two or more chronic conditions

Reimbursement ranges from $15 to $110 per patient, per month depending on patient complexity and service availability.

Learn more: APCM Billing Codes and How to Use Them

Quality measurement

While billing and documentation are central to all three programs, only APCM requires formal quality measurement. This means practices participating in APCM must track and report specific metrics to remain compliant. PCM and CCM, while still requiring thorough documentation, do not have mandatory quality reporting tied to reimbursement.

Should you choose PCM, CCM, or APCM?

The best care management program for your practice depends on your patients’ needs and your team’s capacity. Start by looking at your Medicare population: How many patients have no chronic conditions? How many have one? How many are managing two or more? Also consider which of your patients have Qualified Medicare Beneficiary (QMB) status.

PCM often makes the most sense for specialists—like cardiology or oncology practices—who serve as the main point of support for patients with a single high-risk condition. It’s designed for at least three months of focused care, with the goal of stabilizing patients and, when appropriate, handing their management back to primary care. Just remember: PCM requires 30 minutes of care activities per month, so make sure your team can dedicate that time.

CCM is a better fit for patients juggling two or more chronic conditions that need long-term coordination, while APCM focuses on prevention and early intervention for a wider Medicare population, including those without chronic illnesses. Many practices find success running APCM alongside CCM to reach both lower-risk and more complex patients—just be mindful of the resources needed to start and sustain each program.

Ultimately, the choice comes down to patient needs. If most of your patients have a single high-risk condition, PCM may be the best fit. If you see more patients with multiple chronic illnesses, CCM likely offers more value. And if your goal is to improve overall health outcomes across all Medicare patients, APCM can help you engage them before their risks escalate.

Each of these programs requires consistent care coordination and administrative support to succeed. Partnering with an organization like ChartSpan can help by providing you with experienced care managers, handling much of the administrative lift, and ensuring your practice can meet program requirements without overextending your staff.

Can you bill more than one care management program concurrently?

In most cases, patients can only be enrolled in one care management program during a single billing month. However, there is one exception: PCM and CCM may be billed together when two different providers are involved—typically, a specialist managing one condition through PCM and a primary care provider overseeing CCM for separate chronic conditions. In these situations, each program must have its own care plan tailored to the condition being managed. Without different providers, distinct conditions, and separate plans, both programs cannot be billed simultaneously.

How ChartSpan can support your care management programs

More than the right codes and a willing patient population, launching and maintaining a successful care management program takes time, coordination, and ongoing engagement. Many practices struggle to find the staff capacity or operational infrastructure to manage these programs effectively, which can limit their impact or delay their launch altogether.

ChartSpan partners with practices to make Chronic Care Management and Advanced Primary Care Management more accessible and sustainable. Our team of experienced care managers handles the day-to-day patient outreach, education, and follow-up, while also managing the documentation and reporting needed for compliance and reimbursement. This approach not only helps your practice deliver consistent, high-quality care to your Medicare patients but also reduces the administrative burden on internal staff, freeing your team to focus their time and efforts on treating patients.

Expand your practice’s care management services without the growing pains of building a program from scratch. Talk to an expert to learn how ChartSpan can help you improve patient outcomes and practice revenue*.