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.

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.

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.