For Providers

Medicare Billable Revenue Calculator

Model net new revenue from stacked CMS care management programs — RPM, CCM, PCM, BHI, and supplemental codes — using 2026 Physician Fee Schedule national averages.

Configure your Medicare panel size, enrollment assumptions, and program stack to see projected annual revenue, per-1,000-lives yield, and per-patient PMPM. Toggle Advanced mode to explore add-on programs, Medicare Advantage uplift, and custom stack distributions.

RPM + CCM only

Panel Configuration

Total Patient Panel All patients in your panel (all payers)

Medicare FFS (Part B) Mix (%) Percentage of panel on traditional Medicare Part B

FFS Lives: 450 Medicare Part B patients

Eligibility & Enrollment Funnel

RPM and CCM have different eligibility thresholds and operational realities. RPM is broader (1+ chronic condition) but operationally harder. CCM is narrower (2+ conditions) but more stable.

1 Clinical Eligibility

RPM

Eligible (%) 1+ chronic condition (~75-85%)

CCM

Eligible (%) 2+ chronic conditions (~55-65%)

2 Patient Enrollment

Enrollment Rate (%) Percentage who agree to enroll — applies to both programs (40-60% typical)

3 Operational Compliance

RPM

Compliance (%) 2-day/month device threshold — 2026 CMS rule (~70-80%)

CCM

Compliance (%) Care plan + documentation (~60-70%)

RPM Billable: 135 450 × 80% × 50% × 75%

CCM Billable: 88 450 × 60% × 50% × 65%

FFS Lives: 450

RPM Billable: 135

CCM Billable: 88

Revenue Assumptions

RPM PMPM ($) 99454 ($47) + 99457 ($52) + 99458 ($41) — 2026 PFS

CCM PMPM ($) 99490 ($66.13 national avg) — 2026 PFS

Revenue Projection

Total Annual Revenue $542,746 Net new billable

Per 1,000 Lives $542,746

PMPM (Billable) $170

Revenue Breakdown

Core Recurring Revenue

Program	Patients	Calculation	Annual
Subtotal (Recurring)			$456,420

Add-On Programs

Program	Patients	Calculation	Annual
Subtotal (Add-Ons)			$86,326

Medicare Advantage Uplift

MA Incremental Revenue

Calculation Notes

Based on 2026 CMS Physician Fee Schedule national averages
Payer mix default reflects rural Southern IL modeled reality (~44–49% FFS)
Billable base applies full funnel: Panel → FFS% → Clinical Eligibility → Enrollment → Compliance (2-day/month device threshold per 2026 CMS rule)
RPM revenue includes 99454 ($47) + 99457 ($52) + 99458 ($41 add-on for additional 20 min) — 2026 PFS
~40–45% of FFS patients typically convert to actual billable revenue after all filters
RPM eligibility is broader (~75-85%) than CCM (~55-65%), but CCM is operationally more stable — each has independent funnels with separate compliance rates
FFS is ~65–75% of reliable billable revenue even at ~45% of patient count (MA = policy risk + carve-outs)
CCM and PCM are mutually exclusive — patients receive one or the other
BHI (99484) stacks on top of RPM/CCM/PCM — not mutually exclusive
Add-on programs are time-limited (average months active varies by program)

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