top of page

RPM VS PCM - What's the difference?

Principal Care Management (PCM) and Remote Patient Monitoring (RPM) are two approaches healthcare providers can implement to improve patient engagement, augment education and information sharing about health outcomes and positive lifestyle changes, and ensure patients are empowered to actively participate in their care.

Virtual healthcare has become one of the fastest-growing models within modern healthcare delivery, with benefits in terms of resource consumption, personalization, and reducing barriers to care, which both RPM and PCM achieve – often in conjunction.

Wanda Health explains how these services contrast and differ while exploring ways forward-thinking healthcare providers can improve long-term outcomes. So what are the main differences between RPM and PCM?

What Is Principal Care Management (PCM) in Healthcare?

PCM was first introduced by the Centers for Medicare and Medicaid Services (CMS) in 2020 to provide supplementary care or additional support for patients following the diagnosis of a chronic condition.

The program also aims to facilitate healthcare support between providers treating patients with two or more chronic conditions, primarily focusing on one disease.

Previously, the CMS would only have issued reimbursements through the Chronic Care Management (CCM) program for healthcare services treating patient cohorts with at least two chronic health conditions - but recognized the gap.

Practitioners who treat patients to help manage an individual chronic condition but where other diseases may be present can use the PCM model as an alternative to secure appropriate reimbursements to support ongoing patient care.

RPM in Contrast to PCM

RPM is a key factor in the rapid growth of virtual care management and telehealth services, providing patients with FDA-approved medical monitoring devices to capture data about their health measurements from the comfort of their own homes and transmitting this data securely to their physicians for logging, tracing, and analysis.

A remote patient monitoring solution aims to monitor chronic conditions and ensure interventions and emergency responses are implemented immediately, with real-time alerts that signify when a submitted reading is beyond the baseline tolerance and may represent a concern.

RPM programs are based on physiological data, which could include body weight, temperature, blood pressure, blood oxygen levels, or blood sugar readings. RPM devices ensure that healthcare teams receive patient measurements and can assess them to determine whether further care is required or whether the patient data signifies stability or a positive improvement.

Comparing RPM vs. PCM Healthcare Services

Perhaps the easiest way to differentiate between RPM and PCM is to align the objectives, requirements, and criteria for each program on a like-for-like basis.

RPM vs. PCM Objectives

The primary goal of RPM is to monitor and capture data related to specific parameters around patient health, such as those mentioned above, either between in-person consultations or as an alternative for patients with barriers to care, such as rural patient demographics or those with limited mobility.

In contrast, PCM aims to manage and coordinate chronic conditions, often concentrating on one prevalent disease, alongside and between regular practitioner appointments, and suited to patients with one complex condition or who are otherwise unsuited to CCM healthcare programs.

Requirements and Data Measurements

RPM programs require patients to be equipped with an FDA-approved medical tracking device and to submit at least 16 readings per month or more to be eligible for specific RPM CPT reimbursement codes. There are no such measurements or data collection requirements associated with PCM.

Ordering Physicians or Medical Professionals

A qualified practitioner, physician, or clinician can enroll any patient into an RPM program where they identify a medical need or a necessity that will benefit the patient’s long-term health and well-being.

To enroll a patient into a PCM program, the healthcare provider must have diagnosed or taken over the care of a patient with one high-risk disease or chronic condition that is anticipated to last at least three months.

Both services can be ordered by physicians and qualified healthcare professionals, although RPM service delivery can be outsourced or delegated under the supervision of the original ordering practitioner.

Clinical Time Requirements

RPM requires at least 20 minutes of time allocation per month, including at least one real-time interaction with the patient. Other activities include data assessments, logging, and consultations with medical professionals.

PCM has a similar requirement but an extended 30-minute minimum of time contributed by a qualified healthcare professional, clinician, or physician every month for the service to be claimable.

CPT Coding

These two virtual healthcare services have different allocated CPT codes, where RPM programs use:

  • CPT 99453: the initial set-up and configuration of approved RPM devices.

  • CPT 99454: the supply of the RPM device and set-up of daily monitoring processes.

  • CPT 99457: the first 20 minutes of time, including one patient interaction and other consultative, analysis, and assessment tasks.

  • CPT 99458: each subsequent 20 minutes of RPM time, depending on patient needs.

PCM services use a separate set of CPT codes to claim reimbursements and log interactions and activities, including:

  • CPT 99424: an initial 30 minutes of care planning time per calendar month.

  • CPT 99425: each additional 30 minutes, such as ongoing revisions and active medication management.

  • CPT 99426: covers the first 30 minutes of time provided by clinical staff under the supervision of a qualified medical professional.

  • CPT 99427: each additional 30 minutes of clinical time as above.

How Are RPM and PCM Different?

PCM is centered around one prevalent chronic condition and delivers targeted information and healthcare to stabilize that condition and prevent avoidable escalations. The concept is that clinicians can reduce long-term healthcare costs promptly by providing immediate care where required.

As many as 60% of the US population has at least one chronic condition, and the anticipated outcome is that PCM will become an important aspect of primary care, helping to reduce healthcare costs and deliver better patient outcomes.

While RPM has similar big-picture aspirations, it is reliant on technological monitoring. It applies to a broader array of circumstances, such as in care for older people, post-surgery patients, and chronic care patient cohorts.

The information collected through regular measurements enhances the depth of data available to clinicians and practitioners, meaning they can intervene faster and in a more targeted way. Outcomes include reduced in-person appointments and visits, reduced hospital admissions and readmissions, and more cooperative interactions between physician and patient.

For more information about remote patient monitoring solutions vs PCM, please get in touch with the Wanda Health team at any time.


Popular Articles

bottom of page