The Centers for Medicare and Medicaid Services (CMS) has updated the Final Rule for Behavioral Health Integration (BHI) for 2025. While there were no major changes to the BHI program rules and regulations in this Final Rule, it is significant that, for the first time, Rural Health Clinics and Federally Qualified Health Centers are now permitted to bill for the BHI CPT codes, just like other fee-for-service practices. Additionally, there are updated reimbursement rates for these CPT codes.

What is Principal Care Management? Principal Care Management (PCM) is a preventive program that helps patients mitigate one, specific chronic condition. Covered by Medicare Part B, providers should learn what CPT billing codes are used for PCM in order to optimize care delivery and avoid denied claims.

Annual Wellness Visits (AWVs) have been shown to reduce healthcare expenses by 5.7% for Medicare beneficiaries. In addition to reducing future costs, AWVs provide an opportunity to assess a patient’s health risks and create a personalized prevention plan.

What is a Medicare Annual Wellness Visit? A Medicare Annual Wellness Visit (AWV) is a preventive screening used to identify gaps in care.

Transitional Care Management (TCM) was developed by the Centers for Medicare & Medicaid Services (CMS) mainly for adults older than 65. However, the model presented through its requirements and the CPT codes that CMS reimburses is also accessible to clinicians serving patients under 65. Additionally, many commercial payors cover transitional care through various products and arrangements, which we will explore.

Care coordination includes organizing patient activities and services across multiple providers. The approach prioritizes communicating all relevant information to the participants involved in the person’s care. Its overall objective is to fulfill an individual’s care needs and preferences through high-quality, personalized engagement.

One of the powerful aspects of Medicare care management programs is that some are designed to work together. A primary example is offering Chronic Care Management (CCM) alongside Remote Patient Monitoring (RPM).

What is Transitional Care Management? Transitional Care Management (TCM) helps patients in the first 30 days following a hospital discharge. Covered by Medicare Part B, providers should learn what CPT billing codes are used for TCM in order to optimize care delivery and avoid denied claims.

The Centers for Medicare and Medicaid Services (CMS) has updated the 2025 Final Rule for Chronic Care Management (CCM). For 2025, there were no major changes to the CCM program rules and regulations in CMS’s Final Rule, but for the first time, Rural Health Clinics and Federally Qualified Health Centers can now bill the CCM CPT codes just like other fee-for-service practices. There are also updated reimbursement rates for the CPT codes.