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Rural Health Information Hub

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‚Äôs medical and social history and provide counseling about preventive services. Also includes information on the Initial Preventive Physical Exam (IPPE), or “Welcome to Medicare” visit.
  • Chronic Care Management: Monthly non-face-to-face support for beneficiaries with two or more chronic conditions. Also includes information on Principal Care Management, monthly non-face-to-face support for beneficiaries with a single high-risk disease. Also includes behavioral health integration (BHI) services and the Psychiatric Collaborative Care Model (CoCM) to facilitate care management for patients with behavioral health needs.
  • 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.

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


Last Reviewed: 6/5/2024