Care Management Services

230 – Care Management Services (Rev. 13600; Issued: 02-20-26; Effective: 01-01-26; Implementation:03-23-26) Care coordination services are RHC and FQHC services and include transitional care management (TCM), chronic care management (CCM), principal care management (PCM), chronic pain management (CPM), general behavioral health integration (BHI), Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Community Health Integration (CHI), Principal Illness Navigation (PIN), Principal Illness Navigation Peer Support (PIN-PS), Advanced Primary Care Management (APCM) and psychiatric collaborative care model (CoCM) services. The RHC and FQHC face-to-face requirements are waived for these care management services. Effective January 1, 2017, care management services furnished by auxiliary personnel may be furnished under general supervision. (Note: General supervision does not require the RHC or FQHC practitioner to be in the same building or immediately available, but it does require the services to be furnished under the overall supervision and control of the RHC or FQHC practitioner.) Except for TCM services, care management services are paid separately from the RHC AIR or FQHC PPS. Prior to January 1, 2022, RHCs and FQHCs could not bill for care management services for a beneficiary if another practitioner or facility had already billed for care management services for the same beneficiary during the same time period. Effective January 1, 2022, RHCs and FQHCs may bill for care management and TCM services and other care management services (outside of the RHC AIR or FQHC PPS), for the same beneficiary during the same time period. Coinsurance and deductibles are applied as applicable to RHC claims, and coinsurance is applied as applicable to FQHC claims. Effective January 1, 2025, RHCs and FQHCs are required to bill the individual codes that make up the general care management HCPCS code, G0511. RHCs and FQHCs must report the individual CPT/HCPCS base codes and add-on codes (as necessary) for each of the care coordination services which replaced the reporting of HCPCS code G0511. Note: Effective January 1, 2026, RHCs and FQHCs can bill care coordination services established under the Physician Fee Schedule (PFS) as designated care management services. The care coordination codes can be found in the table entitled Designated Care Management Services, which is published annually with the PFS Final Rule Addenda on the CMS website. Care coordination services are paid separately and should meet all of the billing requirements. Except for TCM services, which can be an RHC or FQHC visit (see section 230.1 of this Chapter).