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Principal Care Management Codes: An Underutilized Tool to Capture Preoperative Optimization Care
Riya D Malhotra1,2, Sharika Kaul1,2, Zoë A Walsh1
1MaineHealth Orthopedics & Sports Medicine, Maine Medical Center, Portland, ME, USA.
Arthroplasty Today
|April 13, 2026
Summary
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.
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.
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