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

Principal care management (PCM) codes 99424-99427 were approved by the Centers for Medicare and Medicaid Services and the Relative Value Scale Update Committee in 2022 to capture preoperative care and optimization provided by orthopaedic surgeons for patients undergoing total joint arthroplasty. However, real-world utilization and reimbursement remain poorly defined. We evaluated PCM code use and payer reimbursement at our institution during the 2024 calendar year. Current Procedural Terminology code 99424 was billed in 42% of eligible procedures (789 of 1877). Payers reimbursed an average of 42.5% of total charges, corresponding to $66.09 for a hospital charge of $155.44, with private payers reimbursing a higher proportion than public payers. These findings suggest PCM codes are underutilized and partially reimbursed, highlighting their potential to turn the tide against declining total joint arthroplasty reimbursement.