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Care Management Medicare Reimbursement Strategies for Rural Providers

The Centers for Medicare & Medicaid Services (CMS) has established Medicare billing codes for services intended to keep beneficiaries healthy and better coordinate services to support beneficiaries at home. Each of the guides below provides a brief overview and links to key documents to help rural healthcare professionals, practices, and hospitals understand the billing code, consider the benefit to their patients and organization, and begin billing for the code. These guides include:

  • Annual Wellness Visits: Yearly visit to review a beneficiary’s medical and social history and provide counseling about preventive services.
  • Chronic Care Management: Monthly non-face-to-face support for beneficiaries with two or more chronic conditions.
  • Transitional Care Management: Certain non-face-to-face services and face-to-face visit for beneficiaries in the 30 days after discharge from an acute care setting.
  • Principal Care Management: Monthly non-face-to-face support for beneficiaries with a single high-risk disease. CMS added Principal Care Management (PCM) as a new benefit for 2020 billable under HCPCS codes G2064 and G2065. See the CY 2020 final rule in the Federal Register for more information. For 2021, CMS announced that RHCs and FQHCs may begin furnishing PCM services while billing HCPCS code G0511. See the CY 2021 final rule in the Federal Register for more information pertaining to RHCs and FQHCs.

More information on care management can also be found on the Care Management section of the CMS website.


Last Reviewed: 12/15/2020