PCM services focus on patients with a single high-risk chronic condition and must be delivered by qualified healthcare professionals. Eligible providers, as defined by CMS guidelines, include Physicians and Non-Physician Practitioners (NPPs), Primary Care Physicians (PCPs), specialists such as cardiologists, pulmonologists, and endocrinologists, Nurse Practitioners (NPs), Physician Assistants (PAs), and Clinical Nurse Specialists (CNSs). These providers can bill directly for PCM services and are responsible for overseeing the management of the patient’s high-risk condition.
Clinical staff, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and, where permitted by state law, Medical Assistants (MAs), can carry out PCM services under the general supervision of a billing provider. While the supervising physician or NPP does not need to be physically present, they must oversee the care plan and ensure proper documentation. PCM services can be offered through a variety of organizations, including hospitals and health systems, independent physician practices, specialty clinics (such as cardiology, nephrology, or pulmonology), and remote care or telehealth companies that employ eligible providers.

Per your care focus, MoonMD helps determine patient eligibility for the PCM program. General guidelines include:

• Patients who qualify for PCM typically have one chronic condition that is expected to last at least 12 months or until the patient’s death.

• PCM program members should be established patients who have previously received an evaluation and management service, either in person or through telehealth.

• Patients cannot be enrolled in another PCM or CCM program at the same time.

• Nursing home patients are eligible for PCM participation.

• High risk chronic condition that is life threathening and requries intensive clinical management Conditons are uncontrolled diseases, uncontrolled hypertension, Advanced dementia, chronic pain under active medication adjustment, heart failure decompensation and more.