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.

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.

UPDATE (1/8/2025): In its 2025 Final Rule, CMS changed the rules pertaining to HCPCS code G0511. Read here for the latest information. Since Medicare introduced care management programs in 2015, coverage has evolved to provide expanded opportunities for Rural Health Clinics and Federally Qualified Health Centers. Historically, however, new care management programs have been launched without initially including RHCs and FQHCs or with significant restrictions.

With an Annual Wellness Visit (AWV), your patient receives an appropriate opportunity to review Advance Care Planning (ACP). You can use this yearly assessment as a time to cover why advanced planning can be of great benefit. In this video, we discuss everything you need to know about the 2024 CPT codes, billing requirements, and reimbursements for Advance Care Planning (ACP), so you can properly bill for this program and maximize your revenue. This includes code 99497 and add-on code 99498. Download an Advance Care Planning guide to help you manage your program.

Understanding the CPT billing codes for Behavioral Health Integration (BHI) will provide you with a better idea of what is expected, both by the patient and by Medicare.