Care Management Fees

Care management (CM) generally refers to team-based, patient-centered primary care strategies. In these strategies, family physicians, care teams and other health care professionals work collaboratively with patients and their support systems to manage both acute and chronic conditions, while also promoting prevention and enhancing self-management skills. CM activities may include, but are not limited to, patient and caregiver education; medication management and adherence support; risk stratification; population management; coordination of care and care planning. (See American Academy of Family Physicians (AAFP) policy on "Medical Home")

The AAFP’s position on CM fees for family physicians is as follows:

  1. CM is an ongoing service that necessitates predictable, prospective payment, such as per-patient-per-month CM fees.
  2. CM fees should reflect the breadth and scope of team-based care models and should not place limitations on how teams deliver care management nor should they include time-tracking or reporting requirements.
  3. Payment to practices for improved outcomes or health cost savings should be addressed separately from CM fees, as CM fees are typically insufficient to defray start-up and implementation costs associated with such savings.Additionally, to the extent that CM fees are included in risk-based arrangements, they should not be mandated by a payer to be subject to downside risk or otherwise subject to recoupment and/or reconciliation.
  4. CM fees typically reflect services that are not otherwise billable under fee-for-service payment models. Consistent with the AAFP’s policy on ”Risk Adjustment in Value-based Payment Models for Primary Care (Position Paper),” CM fees should be risk adjusted and paid on a prospective basis.
  5. Payers should clearly delineate the scope of CM fees, and such fees should not be limited to a narrow or predefined list of fee-for-service codes.
  6. If CM fees include a defined set of existing Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, payment should be commensurate with the billable payments which would otherwise be received for providing these services. The fees must adequately support the financial viability of care management services.
  7. Payers should not dictate how a practice uses its CM fees nor impose overly restrictive eligibility requirements (e.g., formal certifications).
  8. Any payer-imposed restrictions on CM fees should be transparent and clearly reflected in contract language.


(2004) (July 2026 BOD)

See Also