Free reimbursement calculator
What your care management programs are actually worth
Estimate monthly and annual Medicare reimbursement for RPM, CCM, PCM, APCM, TCM, RTM, BHI and MTM. Set your patient volumes, edit any rate, and see the revenue each program contributes — with the CPT codes behind every number.
No email required Rates from our CPT library Updates as you type Gross and net revenue
Choose your programs and volumes
Every rate below is a Medicare national average and every one of them is editable — change a rate to match your locality or your contracted rate and the totals follow.
RPM — Remote Patient Monitoring99454 device supply ($55) + 99457 first 20 minutes ($50)
enrolled patients / mo
$
$21,000per month
CCM — Chronic Care Management99490 first 20 minutes of clinical staff time ($60)
enrolled patients / mo
$
$12,000per month
PCM — Principal Care Management99426 first 30 minutes of clinical staff time ($60)
enrolled patients / mo
$
$0per month
APCM — Advanced Primary Care ManagementG0557 level 2, two or more chronic conditions ($50)
attributed patients / mo
$
$0per month
TCM — Transitional Care Management99495 moderate complexity, one per discharge ($180)
eligible discharges / mo
$
$0per month
RTM — Remote Therapeutic Monitoring98977 device supply ($55) + 98980 first 20 minutes ($50)
enrolled patients / mo
$
$0per month
BHI — Behavioral Health Integration99484 general BHI, 20 minutes of care management ($50)
enrolled patients / mo
$
$0per month
MTM — Medication Therapy Management99605 initial 15-minute medication review ($50)
reviews / mo
$
$0per month
100%
The share of enrolled patients you actually bill in a given month. Device non-transmission, missed time thresholds and mid-month disenrollment all land here — most mature programs sit between 75% and 90%.
Include program costs
Platform fees, devices and care-team time, as one blended cost per patient per month. Turn this on to see net revenue and margin instead of gross.
$
per patient / monthEstimated monthly revenue
$33,000
$396,000 a year at this volume
Planning estimate only. Medicare national averages, non-facility, before geographic adjustment.
A worked example
What 200 RPM patients really generate
The number most practices quote is the gross one. Here is the same panel at each of the three stages that matter — and the gap between the first and the last is why programs miss their forecast.
Gross, every patient bills$252,000
200 patients × $105 a month × 12. This is the figure most RPM calculators stop at.
At an 80% billing rate$201,600
Device non-transmission and missed time thresholds knock out roughly one month in five across the panel.
Net of $25/patient costs$153,600
Platform, devices and care-team time. Still a strong margin — but a different business case than $252,000.
The rates behind the maths
Every CPT code this calculator uses
National average allowables, non-facility. Codes marked one-time pay once per enrollment and are excluded from the monthly figure above.
| Code | What it pays for | National average |
|---|---|---|
| Remote Patient Monitoring (RPM) | ||
| 99453 | Setup and patient educationone-time | $20 |
| 99454 | Device supply, 16+ days of readings | $55 |
| 99457 | First 20 minutes of management | $50 |
| 99458 | Each additional 20 minutes | $40 |
| Chronic Care Management (CCM) | ||
| 99490 | First 20 minutes, clinical staff | $60 |
| 99439 | Each additional 20 minutes | $45 |
| 99491 | First 30 minutes, physician/QHP | $80 |
| 99487 | Complex CCM, first 60 minutes | $130 |
| Principal Care Management (PCM) | ||
| 99424 | First 30 minutes, physician/QHP | $80 |
| 99425 | Each additional 30 minutes, physician | $60 |
| 99426 | First 30 minutes, clinical staff | $60 |
| 99427 | Each additional 30 minutes, staff | $45 |
| Advanced Primary Care Management (APCM) | ||
| G0556 | Level 1 — one or no chronic condition | $15 |
| G0557 | Level 2 — two or more chronic conditions | $50 |
| G0558 | Level 3 — QMB with two or more conditions | $90 |
| Transitional Care Management (TCM) | ||
| 99495 | Moderate complexity, visit within 14 days | $180 |
| 99496 | High complexity, visit within 7 days | $230 |
| Remote Therapeutic Monitoring (RTM) | ||
| 98975 | Setup and patient educationone-time | $20 |
| 98976 | Respiratory device supply | $55 |
| 98977 | Musculoskeletal device supply | $55 |
| 98980 | First 20 minutes of management | $50 |
| 98981 | Each additional 20 minutes | $40 |
| Behavioral Health Integration (BHI) | ||
| 99484 | General BHI, 20 minutes | $50 |
| 99492 | CoCM initial month, 70 minutes | $140 |
| 99493 | CoCM subsequent month, 60 minutes | $120 |
| 99494 | CoCM each additional 30 minutes | $65 |
| Medication Therapy Management (MTM) | ||
| 99605 | Initial review, 15 minutes | $50 |
| 99606 | Subsequent review, 15 minutes | $50 |
| 99607 | Each additional 15 minutes | $20 |
Program by program
Where the revenue actually comes from
Eight billable programs, each with a different eligibility rule, time threshold and billing rhythm. The default rate in the calculator is the stack a typical enrolled patient bills every month.
Remote Patient Monitoring$105 per patient / month
Physiologic data from connected devices — BP cuffs, weight scales, glucometers, pulse oximeters. Recurring monthly revenue as long as the patient transmits 16 days and a clinician spends the time.
Chronic Care Management$60 per patient / month
Non-face-to-face coordination for patients with two or more chronic conditions. Add 99439 for each extra 20 minutes, or move to complex CCM (99487) when the month runs long.
Principal Care Management$60 per patient / month
One serious, high-risk condition rather than two or more — the specialty-practice equivalent of CCM. A cardiology or endocrinology panel usually qualifies for PCM where it would fail CCM eligibility.
Advanced Primary Care Management$50 per patient / month
A monthly bundle with no time threshold — you bill the tier the patient falls in, not the minutes you logged. Replaces CCM for the panel you move across; the same patient cannot be billed for both.
Transitional Care Management$180 per discharge
Episodic, not recurring: one claim per qualifying discharge, with a contact inside two business days and a visit inside 7 or 14 days. Volume here is discharges per month, not enrolled patients.
Remote Therapeutic Monitoring$105 per patient / month
Therapy adherence and response rather than physiologic data — musculoskeletal, respiratory and medication adherence. Bills alongside RPM when the patient is monitored for both.
Behavioral Health Integration$50 per patient / month
General BHI at 99484, or the Collaborative Care Model codes when a psychiatric consultant and a registry are in place — CoCM pays substantially more per patient.
Medication Therapy Management$50 per review
Pharmacist-led medication review and adherence work. Usually periodic rather than monthly for a given patient, so enter reviews performed per month.
Who this is for
Built for the person who has to defend the number
- Practice administrators sizing a program before committing staff to it.
- Billing and RCM teams checking what a code mix is worth at their volume.
- Specialty clinics deciding between PCM and full CCM eligibility.
- Primary care groups modelling the move from CCM to the APCM bundles.
- MSOs and digital health startups building a per-patient unit economics model.
- Executives who need the gross, the realistic and the net side by side.
What this calculator assumes
- Rates are Medicare national averages from the HealthArc CPT library, non-facility. Your locality adjustment, payer mix and contracts will move them.
- Recurring programs assume one billable month per enrolled patient. The adherence control applies a single billing rate across all of them.
- One-time codes — 99453 RPM setup and 98975 RTM setup — are excluded from the monthly figure, because they only pay once per enrollment.
- CCM and APCM cannot both be billed for the same patient in the same month. Count each patient in one row only.
- TCM is per qualifying discharge, not per enrolled patient per month.
Questions we get
Reimbursement questions, answered
How much revenue does one RPM patient generate per month?
About $105 a month for a typical enrolled patient: $55 for 99454 (device supply with at least 16 days of readings) plus $50 for 99457 (the first 20 minutes of management). A patient who needs a second 20-minute block adds roughly $40 through 99458, and enrollment itself pays about $20 once through 99453. So a steady RPM patient is $105–$145 a month, not a single fixed number.
How much does Medicare pay for chronic care management?
The base CCM code 99490 averages about $60 for the first 20 minutes of clinical staff time in a calendar month. Each additional 20 minutes adds roughly $45 through 99439. If a physician or qualified health professional personally provides the time, 99491 pays about $80 for the first 30 minutes, and complex CCM (99487) pays about $130 for 60 minutes.
How much revenue can an RPM program generate annually?
Multiply the monthly figure by the months a patient stays enrolled and actually transmits. At $105 per patient per month, 200 enrolled patients is about $21,000 a month and roughly $252,000 a year — but only if every patient bills every month. At a realistic 80% billing rate the same panel is closer to $201,000. The adherence control in the calculator above applies exactly that adjustment.
Can you bill RPM and CCM for the same patient in the same month?
Yes. RPM and CCM are separately billable for the same patient in the same calendar month, and so are RPM and PCM, or RPM and BHI. What you cannot do is count the same minutes twice — time spent on RPM management cannot also be counted toward the CCM time threshold, and your documentation has to show the split.
Can CCM and APCM be billed for the same patient?
No. APCM replaces CCM for a patient rather than adding to it: the G0556–G0558 bundles cannot be billed in the same month as CCM, PCM or the care management codes they subsume. When you model APCM in this calculator, move those patients out of the CCM row rather than counting them in both.
Are these reimbursement rates guaranteed?
No. Every figure here is a Medicare national average allowable. Your actual payment is adjusted by geographic locality through the Physician Fee Schedule, differs between facility and non-facility settings, and is subject to the annual conversion factor. Commercial and Medicare Advantage rates vary by contract. Treat the output as a planning estimate, not a payment forecast.
Why is TCM measured in discharges instead of patients?
TCM is episodic. You bill 99495 or 99496 once per qualifying discharge, inside a 30-day window, not every month a patient is on your panel. Entering an enrolled-patient count would overstate it badly, so the TCM row asks for eligible discharges per month.
What does it cost to run these programs?
The usual drivers are platform fees per enrolled patient, connected devices for RPM and RTM, and clinical staff time — most programs need roughly one full-time care manager per 250–350 enrolled patients. Turn on "Include program costs" in the calculator to subtract a per-patient monthly cost and see net revenue and margin instead of gross.
From estimate to enrolled
A forecast is easy. Billing it is the hard part.
HealthArc runs all eight of these programs on one login, with automated CPT time tracking, device data and audit-ready documentation — so the revenue you modelled is the revenue you can actually claim.