Updated 2025 PIP and DBM program manuals are now available
Updated manuals for the 2025 PCP Incentive Program (PIP) and 2025 Disease Burden Management (DBM) program are now available. Access them in our Provider Incentives webpage (login required).
Below is a summary of the updates made:
2025 PIP Manual updates
Care Management measure
The Care Management measure claims information on page 20 has been updated to include lines of business by code as well as the following billable codes:
- G0511: Care coordination services and payment for RHCs and FQHCs only
- G0512: Psychiatric Collaboration Care Model for FQHCs
- G0556: Care Management – one chronic condition
- G0557: Care Management – multiple chronic conditions
- G0558: Care Management – multiple chronic conditions & Qualified Medicare Beneficiary
These five codes were recently added to the commercial fee schedule effective Jan. 1, 2025, will serve to identify members that have received care management services and will count toward the 2% target. Get additional billing and payment information for these codes.
We also clarified the language on page 20 about telephone service / telephone-only codes. It now reads: “While all CM codes may be delivered via telephone service, only one telephone-only code (including 98966, 98967, 98968) will count towards the required incentive touchpoints.”
Disparity of Care measures
The example for the Disparity of Care Measures on page 17 has been updated to replace the Diabetic Eye Exam example with Controlling High Blood Pressure. Note: The example doesn’t encompass all measures included in Disparity of Care, which are listed in full on page 16 of the manual.
2025 DBM Manual updates
The Billing Requirements section on page 17 of the PCP Visit Incentive has been updated to include the below approved CPT code for DBM visits, which was left out in error.
- CPT code 99386