CCM & RPM Billing Calculator
Care management pays by the minute and the threshold. Enter your panel sizes and average minutes to see what CCM and RPM are really worth at CY 2026 Medicare rates.
Care management programs pay for the work between visits — the phone calls, chart reviews and care coordination that keep chronic patients stable. But the codes pay by the minute, the thresholds are strict, and a program that looks profitable on a slide can lose money at real staffing levels. This calculator prices a Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) panel at the official CY 2026 Medicare rates, so you can see the monthly revenue before you enroll a single patient.
Price your CCM and RPM panel
Chronic Care Management (CCM)
RPM — Remote Physiologic Monitoring
The rules that decide what is billable
- CCM eligibility: the patient needs two or more chronic conditions expected to last at least 12 months, a care plan, and documented consent. Only one practitioner can bill CCM for a patient in a month, and time counted toward other care-management codes cannot be double-counted.
- 99490 covers the first 20 minutes of clinical-staff time per month (general supervision); 99439 adds each further 20 minutes. 99491 is the 30-minute code when the billing practitioner personally does the work — a separate model from staff-delivered CCM, which is why this calculator treats the two panels separately.
- RPM device rule: 99454 (device supply with daily recordings) requires at least 16 days of transmitted data in a 30-day period — patients below 16 days earn no device payment that month, however many readings they sent on the days they did transmit.
- 99457 needs at least 20 minutes of treatment-management time in the month, including an interactive communication with the patient or caregiver; 99458 adds each further 20 minutes. 99453 (setup and education) is billed once per episode of care.
- Rates: CY 2026 Medicare national non-facility amounts, computed from the official fee schedule below. Patients' 20% coinsurance is part of these amounts — it is revenue to collect, not revenue collected.
| Code | Service | Total RVU | CY 2026 national rate |
|---|---|---|---|
| 99490 | CCM, first 20 min (clinical staff) | 1.98 | $66.13 |
| 99439 | CCM, each additional 20 min | 1.51 | $50.44 |
| 99491 | CCM, 30 min personally by practitioner | 2.67 | $89.18 |
| 99453 | RPM setup & patient education (per episode) | 0.65 | $21.71 |
| 99454 | RPM device supply, 16+ days of data / 30 days | 1.56 | $52.11 |
| 99457 | RPM treatment management, first 20 min | 1.55 | $51.77 |
| 99458 | RPM treatment management, each additional 20 min | 1.24 | $41.42 |
Data: CMS CY 2026 Physician Fee Schedule Relative Value File (RVU26D) — national non-facility totals at the $33.4009 conversion factor. Locality (GPCI) and sequestration will move real payments; commercial and Medicare Advantage rates differ.
Disclaimer: This tool is for educational and estimation purposes only and does not constitute billing, coding or medical advice. Coverage, coding and payment rules vary by payer and change over time — always verify with the current CMS files and the payer's own policy before submitting claims or making financial decisions.
Frequently asked questions
What are the CCM time thresholds?
99490 requires at least 20 minutes of clinical-staff care-management time in a calendar month; each additional full 20 minutes supports one unit of 99439. Code 99491 instead covers 30 minutes of care management performed personally by the billing practitioner. Time cannot be counted toward two care-management services, and only one practitioner may bill CCM for a patient in a month.
Why does the RPM device code pay nothing for some patients?
99454 requires the device to record and transmit data on at least 16 days of a 30-day period. A patient who transmits on 12 days generates no device-supply payment that month, regardless of how good the data is. That single rule is the most common reason real RPM revenue lands below the projection — which is why this calculator asks for the 16-day count separately.
Are these the amounts a practice actually receives?
They are the CY 2026 Medicare national non-facility allowed amounts, before locality adjustment (GPCI), sequestration and patient cost-sharing. The 20% coinsurance is included in the allowed amount and must be collected from the patient or a secondary payer. Commercial and Medicare Advantage contracts pay their own rates.