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Principal Care Management Codes: An Underutilized Tool to Capture Preoperative Optimization Care.

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Principal care management (PCM) codes are underutilized by orthopaedic surgeons for total joint arthroplasty patients. Reimbursement rates are low, averaging 42.5%, indicating a need for better adoption and payment policies.

Keywords:
Billing utilizationPreoperative optimizationPrincipal care managementReimbursementTotal joint arthroplasty

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Area of Science:

  • Orthopaedic Surgery
  • Health Services Research

Background:

  • Principal care management (PCM) codes 99424-99427 were introduced in 2022 for preoperative care in total joint arthroplasty.
  • Real-world utilization and reimbursement of these codes remain unclear.

Purpose of the Study:

  • To evaluate the utilization and payer reimbursement of PCM codes at a single institution during 2024.
  • To assess the financial impact of PCM code adoption in total joint arthroplasty.

Main Methods:

  • Retrospective analysis of Current Procedural Terminology (CPT) code 99424 billing for eligible total joint arthroplasty procedures.
  • Calculation of average reimbursement rates as a percentage of total charges for all payers.

Main Results:

  • CPT code 99424 was billed for 42% of eligible procedures (789/1877).
  • Average reimbursement was 42.5% of charges ($66.09/$155.44).
  • Private payers reimbursed a higher proportion than public payers.

Conclusions:

  • PCM codes are underutilized in total joint arthroplasty preoperative care.
  • Reimbursement for PCM codes is partial, averaging less than half of billed charges.
  • Increased utilization and improved reimbursement policies for PCM codes could support declining total joint arthroplasty reimbursement.