Chronic care revenue
Sizes your CCM, RPM, AWV, and TCM billing opportunity based on your patient panel.
What you'll get
Eligible-patient counts for CCM, RPM, AWV, and TCM (with confidence range)
Assumes: Eligibility uses CMS coverage rules applied to your reported Medicare/MA panel size; ±15% confidence band reflects unknown diagnosis distribution.
Annual revenue potential per program, modeled at your specific payer mix
Assumes: Reimbursement uses 2024 rates for CPT 99490, 99491, 99457/58, G0438/39, 99495/96; commercial uplift = your reported multiplier × Medicare.
Staffing model: FTE hours, role mix, and incident-to billing structure per program
Assumes: Assumes RN-led delivery where allowed in your state; 20-min/patient/month for CCM, 40-min for complex CCM, per CMS time thresholds.
Launch sequence recommendation with month-by-month enrollment ramp
Assumes: Ramp curve assumes 60% enrollment by month 6, 80% by month 12 — not the vendor pitch-deck 95%.
Vendor category guidance (RPM device types, CCM platform tiers) with price bands
Assumes: Categories only — we never recommend specific vendors and take no referral fees.
Sample output
Your panel supports $112K/year in CCM revenue and another $74K in RPM with 0.6 FTE of clinical time.
Who this is for
- Primary care, internal medicine, and chronic-disease specialties
- Practices with a Medicare panel of 200+ patients
- Owners not currently billing care management codes
Not the right fit if
- Practices that already run mature CCM and RPM programs
- Cash-pay or pediatric clinics with no Medicare panel
How we build it
- 1We start from your panel size and Medicare/MA % to estimate eligible patients per program using CMS coverage rules.
- 2Revenue is modeled at current CPT reimbursement (99490, 99491, 99457, 99458, G0438/G0439, 99495/99496) using your payer mix.
- 3Staffing model uses realistic enrollment ramp (60–80% over 12 months) — not the vendor pitch deck number.
What we'll ask in intake
- Active panel size and approximate Medicare/MA percentage
- Top 3 chronic conditions in your panel
- Existing care-coordination staff (RN, MA, LPN) and hours available
- Current CCM/RPM activity, if any
No PHI required. Aggregates, percentages, and estimates are enough.
Frequently asked questions
7 questionsDidn't answer your question? Email us — we reply within 4 business hours.
Want this done with you?
Service Line Launch — from $7,500
We stand up your CCM/RPM program: vendor selection, staff training, billing structure, and a 90-day enrollment ramp.
This is a separate, defined engagement; scope and fee are confirmed before work begins.