Care management services are covered under the Medicare program. This is a central location for all care management services, including links to related CMS resources and references.
These services include advanced care planning, advanced primary care management, behavioral health integration services, chronic care management and transitional care management.
Advance care planning (ACP) is a voluntary, face-to-face service between a physician or other qualified health care professional (QHP) and a patient, family member, caregiver, or surrogate to discuss the patient’s health care wishes if they become unable to make their own medical decisions.
Advanced primary care management (APCM) services combine elements of several existing care management and communication technology-based services.
Behavioral health integration services or BHI is a model of care incorporating behavioral health care into other care, like primary care, to improve mental, behavioral, or psychiatric health for many patients. BHI includes care management services for behavioral health conditions and may be particularly helpful for patients who aren’t improving under other models of care.
Chronic care management services are covered by Medicare for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient.
Transitional care management services are covered by Medicare for a patient following a discharge from a hospital, SNF, or CMHC stay, outpatient observation, or partial hospitalization.
General information regarding the Medicare program overall can be found using the topics located on the left navigation bar. Please subscribe to our mailing lists to stay current with Medicare update and changes.
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