Practice Management

Medicare applies a two-part test, not a list of diagnoses. Here are the criteria, the fourteen conditions CMS names, and the boundaries that point to PCM or APCM instead.

What chronic care management companies do, how they price it, where the compliance exposure actually sits, and the nine questions to ask before signing.

Chronic care management is a Medicare benefit that pays your practice a monthly fee for the care your team already delivers between office visits. If a patient has two or more chronic conditions and a member of your clinical staff spends at least 20 minutes in a calendar month coordinating that patient’s care, Medicare pays…

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….

CMS has proposed that starting January 1, 2027, remote physiologic monitoring and remote therapeutic monitoring may only be billed when furnished by clinical staff directly employed by the billing practice. If your RPM or RTM program runs through a third party vendor, and the rule finalizes as written this fall, you will have roughly eight…

Remote therapeutic monitoring (RTM) is RPM’s counterpart for therapy adherence and response: is the patient doing the home exercise program, using the inhaler, following the treatment plan, and how are they responding. The code family covers three types of therapeutic monitoring (musculoskeletal, respiratory, and cognitive behavioral therapy) and, like RPM, it sits at the center…

Remote physiologic monitoring (RPM) pays practices to track parameters like weight, blood pressure, and pulse oximetry between visits and act on the data. The code family has three components: education and setup, device supply, and treatment management. It is also the code family at the center of the CY 2027 proposed rule, which would require…

Principal care management (PCM) is the single-condition counterpart to CCM. Where chronic care management requires two or more chronic conditions, PCM covers monthly management of one high-risk condition. Per the CMS care management booklet (MLN909188), the condition must be expected to last at least three months and place the patient at significant risk of hospitalization,…

Advanced primary care management (APCM) is Medicare’s newest care management framework, effective January 1, 2025. It replaces the time thresholds that define CCM with a flat monthly payment set by patient complexity: G0556 pays $16.37 for patients with one or fewer chronic conditions, G0557 pays $53.78 for patients with two or more, and G0558 pays…

CPT 99491 is chronic care management billed on the practitioner’s own time: the first 30 minutes each calendar month that a physician or other qualified health care professional personally spends managing a patient with multiple chronic conditions. In 2026 it pays $89.18 nationally in the non facility setting, before geographic adjustment. The add on, CPT…