What Is Care Management?
Care Management is a suite of Medicare reimbursement programs that reward providers, practices, and health systems for helping patients manage chronic conditions between visits.
Launched in 2015 with an initial reimbursement for non-face-to-face clinical support, Care Management has since grown to include more than 25 recurring monthly reimbursements across multiple categories of care. These programs compensate practices for the extra time and attention that quality chronic care requires — while also creating new profit opportunities for keeping better tabs on at-risk patients outside the office.
CMS recognizes time spent on non-face-to-face clinical activities by both providers and staff (starting in 20-minute increments) as eligible for reimbursement. Think of all the ways your team supports high-needs patients: refills, care coordination, patient education, and follow-up calls. Care Management codes now pay for that.
Today, newer technologies that integrate with common EHRs can engage patients virtually and alert your practice when their status changes between visits — and those interactions are reimbursable, too.
It’s not unusual for practices to generate $150,000 or more in annual revenue by applying Care Management to patients they already serve. But as the field grows, so does confusion — from poorly designed programs to outright misleading vendors.
Beyond financial benefit, Care Management improves outcomes, reduces hospitalizations, lowers healthcare costs, streamlines complex care, and enhances patient access and quality of life. It also drives loyalty and growth as patients spread the word that your practice keeps tabs on them, helping them feel better and stay better.
Why “The Care Management Guy”?
Because there’s tremendous potential — and a few pitfalls — in this space.
The Care Management Guy exists to help practices, care teams, and innovators learn from each other: what works, what doesn’t, and how to deliver better care more sustainably.
Join the conversation. Share your experience. Let’s make Care Management work, for everyone.
What are the Categories of Care Management?
Chronic Care Management (CCM)
CCM supports patients with two or more chronic conditions that are expected to last at least 12 months and place them at risk of functional decline or death. It reimburses practices for non-face-to-face care coordination and the time staff and providers spend helping patients manage their conditions between visits.
It often includes medication management, care coordination, patient communication, and monitoring of symptoms. Many CCM programs use technology to alert staff when a patient’s condition changes, enabling early intervention.
Best for:
Primary care practices
Internal medicine groups
Multi-specialty clinics managing chronic populations (e.g., diabetes, hypertension, COPD, CHF)
Remote Patient Monitoring (RPM)
RPM reimburses providers for using connected devices (like blood pressure cuffs, glucose monitors, or scales) to collect and review physiological data from patients at home.
Data from the device is transmitted electronically and reviewed monthly by clinical staff. This allows proactive management of patients with chronic or high-risk conditions.
Best for:
Primary care and family medicine practices
Cardiologists, endocrinologists, pulmonologists
Home health or telehealth organizations
Practices managing hypertension, diabetes, COPD, or heart failure
Principal Care Management (PCM)
PCM is similar to CCM but focused on a single complex chronic condition that requires ongoing clinical management. It’s ideal for patients whose primary challenge is one condition that significantly impacts their health.
PCM reimburses for care coordination, medication management, and patient communication focused on that single condition.
Best for:
Specialists (e.g., cardiology, pulmonology, oncology, neurology)
Practices seeing patients with one high-impact condition requiring intensive management
Advanced Primary Care Management (APCM)
Advanced Primary Care Management (APCM) is a simplification of CCM that does not require time tracking. It can be billed by physicians, nurse practitioners, physician assistants, and clinical nurse specialists who serve as a patient’s ongoing primary care provider and coordinate their overall care.
G0556 (Level 1): For patients with one or fewer chronic conditions or low complexity — basic care coordination and management.
G0557 (Level 2): For patients with two or more chronic conditions at risk of decline — standard, ongoing comprehensive management.
G0558 (Level 3): For Qualified Medicare Beneficiaries (QMBs) with multiple chronic conditions — includes added support for higher social or financial complexity.
Transitional Care Management (TCM)
TCM reimburses practices for helping patients transition from hospital or facility care back to the community. It covers communication within two business days of discharge and a follow-up visit within 7–14 days.
Focuses on preventing readmissions through medication reconciliation, follow-up scheduling, and coordination with home health or specialists.
Best for:
Primary care physicians
Hospitalists coordinating post-discharge care
Practices serving elderly or complex patient populations
Behavioral Health Integration (BHI)
BHI reimburses for systematic coordination between primary care and behavioral health services. It supports monitoring, care plan management, and collaboration between providers.
A care manager tracks patient progress, communicates with behavioral health specialists, and helps integrate mental and physical health care.
Best for:
Primary care providers
Psychiatry and psychology practices
Clinics managing depression, anxiety, or other behavioral health needs alongside chronic disease
Remote Therapeutic Monitoring (RTM)
RTM reimburses for the remote collection and review of non-physiological data — like pain, medication adherence, or physical therapy progress — often gathered via apps or digital platforms.
Patients use connected tools to track symptoms, therapy participation, or recovery progress. Clinicians review this data and intervene as needed.
Best for:
Physical therapists and occupational therapists
Orthopedic and rehabilitation practices
Behavioral health and pain management specialists
Providers offering remote or hybrid follow-up car