Principal care management CPT code 99424 was billed in 42% of eligible procedures, with private payers reimbursing a significantly higher proportion of charges than public payers (44.9% vs 35.3%).
Observational (n=1,877)
No
Principal care management codes are underutilized and only partially reimbursed for preoperative optimization in total joint arthroplasty.
Absolute Event Rate: 44.92% vs 35.31%
p-value: p=<0.001
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.
Malhotra et al. (Mon,) conducted a observational in Total joint arthroplasty (n=1,877). Principal Care Management (PCM) CPT code 99424 billing to private payers vs. Public payers was evaluated on Insurance reimbursement rate for CPT 99424 (Private vs Public payers) (p=<0.001). Principal care management CPT code 99424 was billed in 42% of eligible procedures, with private payers reimbursing a significantly higher proportion of charges than public payers (44.9% vs 35.3%).