For Providers

Medicare Billable Revenue Calculator

Model net new revenue from stacked CMS care management programs — RPM, CCM, PCM, BHI, and supplemental codes — using 2025 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 Managed Lives Medicare beneficiaries in your panel

RPM-Eligible (%) Chronic seniors eligible for RPM (typically 70-80%)

Enrollment & Compliance

Enrollment Rate (%) Percentage who agree to enroll (40-60% typical)

Compliance Rate (%) Meet 16+ day/month threshold (60-80% typical)

Net Billable Base: 266 patients

Revenue Assumptions

RPM PMPM ($) 99454 ($43) + 99457 ($48) + 99458 ($38)

CCM PMPM ($) 99490 ($62.58 national avg)

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 2025 CMS Physician Fee Schedule national averages
RPM revenue includes 99454 ($43.02) + 99457 ($47.87) + 99458 ($38.49 add-on for additional 20 min)
CCM and PCM are mutually exclusive — patients receive one or the other
BHI (99484) stacks on top of RPM/CCM/PCM — not mutually exclusive
APCM (G0556-G0558) is a new 2025 consolidated code — replaces CCM/PCM for select populations
Add-on programs are time-limited (average months active varies by program)
MTM attached to 40% of RPM+CCM and RPM+PCM patients
MA revenue assumes only RPM, CCM/PCM, CHI, PIN reliably convert

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