Table 1. Direct Reimbursement Revenue Opportunities for Care Management
Care manager evaluation and management as an independent provider“Incident to” care of a provider. Allows certain care manager types to bill evaluation and management codes for care manager work in conjunction with the care of a primary care physician
  • Only certain professional types are allowed to use this option, for example, RD and Master of Social Work since they are considered independent providers

Nurse or other provider visit (99211)Office visit for the evaluation and management of an established patient that may not require the presence of a physician
  • Does not pay that well for a visit that often lasts a long time

T-codesEncounter-based billing that allows specified allied health professionals phone or in person visits for disease management for patients with specified chronic conditions
  • Only some insurers have and pay on t-codes

  • Often involves patient copay

  • Allows phone or in-person visit

Medical nutrition therapy (MNT) provided by a registered dietitian (RD)Nutrition counseling provided by an RD
  • Only used by an RD

  • Limited number of visits (3 hours total first year)

  • Must have specific diagnosis (diabetes or chronic kidney disease)

Per member per month fee paymentUsually paid for an entire population, set amount paid to the practice whether care management is given or not
  • May be difficult to correctly attribute the amount needed for the practice population; some arrangements are based on performance metrics achieved

Medicare wellnessCompletion of wellness visit as specified by Medicare
  • Must be enrolled in Medicare anytime in first year

  • Visit requirements for assessment and prevention plan

  • RD, registered dietician.