This calculator compares two ways to run Medicare care management: through an outsourced vendor, or staffed by your own team. Enter your enrolled patient counts, what your vendor charges, and what your own staffing would cost. It returns estimated monthly and annual program revenue at 2026 Medicare national rates, and the net under each model. Everything runs in your browser; nothing you type is sent anywhere.
In house vs vendor revenue estimate
| Program | Per patient per month | Estimated monthly allowed |
|---|---|---|
| CCM (99490) | $66.13 | $0 |
| PCM (99426) | $67.80 | $0 |
| RPM (99454 + 99457) | $103.88 | $0 |
| RTM (98977 + 98980) | $105.55 | $0 |
| Total program allowed amounts | $0 |
Vendor model net, monthly
In house net, monthly
In house vs vendor, annual
Estimates use 2026 Medicare national non facility allowed amounts, before geographic adjustment. The allowed amount includes the roughly 20 percent that is patient responsibility under Part B, which practices must collect rather than waive. Base codes only: add on codes, setup codes, complex CCM, and APCM are excluded, so a program billing add on and setup codes will differ from this estimate. Enter each patient once, under the one program you bill for them. Assumes each counted month meets every billing requirement. Vendor fees are modeled on billable months only; many vendor contracts charge for every enrolled patient regardless of billing, which would make the vendor column worse than shown. The same proposed rule would also revalue these codes for 2027, with CMS proposing lower practice expense values for the device supply and treatment management codes shown here; rerun against the final rates when they publish. This is an educational estimate, not billing, legal, or financial advice.
What the math includes, and what it leaves out
The per patient amounts are the 2026 Medicare national non facility allowed amounts for each program’s base monthly code set: CPT 99490 for CCM, 99426 for PCM, 99454 plus 99457 for RPM, and 98977 plus 98980 for RTM. The estimate is deliberately conservative. It excludes the add on codes that extra time earns (99439, 99427, 99458, 98981), the one time setup codes, complex CCM, and the APCM bundles. It also asks you to set a billable completion rate, because enrollment does not equal billing: a month only bills when the time threshold, data days, consent, and documentation requirements are all met.
Three honest caveats. Allowed amounts are not deposits: Medicare pays about 80 percent and the rest is patient responsibility, which your practice must actually collect. Your locality adjustment will move each rate up or down from the national figure. And the in house number is only real if the staffing cost you enter reflects what a care coordinator actually costs you, fully loaded, for the panel size you entered.
Why the vendor column may go away for remote monitoring
CMS has proposed that starting January 1, 2027, RPM and RTM may only be billed when furnished by clinical staff directly employed by the billing practice. CCM and PCM are not part of that proposal. If it finalizes as written, the vendor scenario above stops being a choice for remote monitoring and becomes a compliance problem. Our plain language breakdown of what the 2027 proposal actually says covers the details, and the 2027 transition checklist walks through the exposure assessment this calculator starts.
Practice Management Consultancy helps practices build care management programs staffed by their own team. If the in house column looks better on your numbers, the next step is a care management assessment: a fixed fee review of your panel and current setup with a written staffing and program recommendation.
Get our analysis the day the final rule publishes
The vendor column’s fate gets decided this fall. We will read the final rule the day it lands and email you what finalized, what changed from the proposal, and what to do about it. No newsletter, just that one analysis.
Sources
- CMS Physician Fee Schedule Relative Value File, July 2026 release (all rates are 2026 national non facility amounts, nonqualifying APM conversion factor, before locality adjustment)
- CY 2027 Physician Fee Schedule proposed rule, 91 FR 43842 (staffing provision at 43892 through 43893)
