Revenue calculator
Model it yourself, with assumptions you can argue with.
Every input is visible and every rate is a published CY2026 CMS national average. The defaults are set low on purpose — we would rather you find the number credible than impressive.
Modelled program revenue
$130,042 / year
$10,837 per month, recurring, at 116 enrolled patients.
Eligible for care management
Medicare patients with two or more chronic conditions
462
APCM, standard tier G0557
82 patients × $53.78/mo
$4,410
APCM, QMB tier G0558
11 patients × $117.24/mo · no patient copay
$1,290
CCM, first 20 minutes 99490
23 patients, 80% of months clearing the threshold
$1,217
CCM, additional 20 minutes 99439
Credited once on 30% of billable months, never twice
$278
RPM, 16+ day tier 99454 + 99457
32 patients, device supply plus first 20 minutes
$3,040
RPM, partial tier 99445
14 patients at 2–15 transmission days
$602
Total monthly program revenue
$10,837
This is gross program revenue, before our fee.
Figures use published national averages and the enrollment rate you set above. We work out our fee with you on the call, once we have seen your practice.
How this is calculated. All rates are CY2026 published national averages. Because APCM and CCM cannot both be billed for the same patient in the same month, the enrolled panel is split between them, never counted twice — moving the CCM slider moves patients across, it does not add them. CCM credits only the months that reach twenty documented minutes, since a month below that pays nothing, and credits the add-on at most once although the code allows it twice. RPM assumes device supply for every monitored patient, the first twenty-minute management tier only for patients clearing sixteen transmission days, and no additional-time add-on. Amounts are before locality adjustment and exclude commercial-payer RPM revenue entirely, even though RPM is widely reimbursed outside Medicare. Real practices bill more than this model shows, and we would rather understate it. Nothing here is a projection, a guarantee, or billing advice.
What this model leaves out
Four reasons the real number is usually higher
We built the calculator to understate, because a model that flatters you is worthless in a room with a sceptical physician in it. Here is what we deliberately excluded.
Commercial and Medicare Advantage RPM
The model counts only traditional Medicare. RPM is widely reimbursed by commercial plans and Medicare Advantage, and since a typical panel is only 30–40% traditional Medicare, this alone can roughly double the monitorable population. Coverage varies by plan and has to be verified, so we left it out entirely.
Additional management time
On monitoring we credit only the first twenty-minute tier, though practices with genuinely sick patients bill the add-on regularly, and there is now a shorter tier for periods with ten to nineteen minutes of work. On CCM we credit the add-on once where the code allows it twice, and we never credit complex CCM, which pays more than double the base rate.
Device setup and everything adjacent
No setup code, no transitional care management for the post-discharge calls this program surfaces, no behavioural-health integration add-ons. All of them are real revenue that appears once the operational rail exists.
The visits that come back
Patients in regular contact with a practice keep their wellness visits and close their care gaps. That effect is real, well documented, and impossible to model honestly — so it is not in here at all.
And one reason it could be lower
The CY2027 Physician Fee Schedule proposed rule would significantly reduce RPM device-supply payment if finalized as written. We model conservatively against that possibility internally, and we would rather you knew about it before signing anything than after. Neither APCM nor CCM is affected by that proposal. What CMS actually proposed.
Now run it against your real panel
The calculator uses assumptions. The panel scan uses your eligibility data — actual counts, actual tiers, actual names, in about thirty minutes.
No EHR change. No commitment.