Over a decade, the Centers for Medicare & Medicaid Services (CMS) tested various value-based innovation models focused on improving primary care. Models like CPC, CPC+, and Primary Care First demonstrated that “comprehensive primary care can lead to reductions in emergency department and hospital visits while better meeting patient needs.”

Medicare’s new program, Advanced Primary Care Management (APCM), moves away from time-based tracking and focuses on reimbursement based on a patient’s risk level. The highest risk level is covered under CPT code GPCM3 and focused solely on any patient who is a Qualified Medicare Beneficiary (QMB).

The Centers for Medicare and Medicaid Services (CMS) updated the CPT codes for the Annual Wellness Visit (AWV). For 2025, there were no major changes to the AWV program rules and regulations in CMS’s Final Rule.

Medicare Advantage (MA) plans are at a pivotal moment. First launched in 1997, these managed care alternatives for Medicare beneficiaries were designed to reduce costs and improve outcomes.

What is Remote Therapeutic Monitoring? The Centers for Medicare and Medicaid Services (CMS) introduced Remote Therapeutic Monitoring (RTM) in 2022. The program reimburses providers for the review and monitoring of non-physiological data collected through medical devices that meet FDA standards.

What is Behavioral Health Integration? Behavioral Health Integration (BHI) is a monthly program that helps Medicare beneficiaries address mental health concerns. Covered by Medicare Part B, providers should learn what CPT billing codes are used for BHI in order to optimize care delivery and avoid denied claims.

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.