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Potential Revenue from RPM and CCM Programs

Number of Patients

Average number of patients per physician (2300 Latest Industry Average)

Number of Physicians

Number of physicians participating (This multiplies above patient count by number of physicians).

Percentage of Medicare Patients at Office

This is number of patients at office that are medicare eligible (27% is 2012 National Avg).

Number of Medicare Patients

This is the raw number of patients that are medicare patients.

Percentage of Chronic Eligible Patients

Percentage of those Medicare patients with appropriate chronic conditions. (2 or more)

Number of Chronic Eligible Patients (As a Number)

Taking the percentage of those medicare patients that are eligible for RPM or CCM.

Percentage Patient Opt-In to RPM or CCM Program

Number of Patients You Expect to Opt in as a Percentage (3C Average is above 75%)

Number of Opt-In Patients to RPM or CCM Program

Estimated Number of Patients You Expect to Opt-In

CPT Codes for Remote Patient Monitoring (RPM)

CPT 99454 Equipment and Monitoring ($69/month)

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

CPT 99457 - Interventions ($54/month)

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/ caregiver during the month

CPT 99453 One time Setup ($21)

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. One time fee can be charged.

CPT Codes for Chronic Care Management (CCM)

CPT 99490 Standard CCM ($42/month )

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: ● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient ● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline ● Comprehensive care plan established, implemented, revised, or monitored

CPT 99487 Complex CCM ($93 /month)

For complex CCM that requires substantial revision of a care plan, moderate or high complexity medical decision making, and 60 minutes of clinical staff time. 60 Minutes - $93 average reimbursement

CPT Code 99489 Complex + 30 ($47 /month)

Complex CCM add-on code for each additional 30 minutes of clinical staff time.

HCPCS Code G0511 ($67 /month)

RHCs and FQHCs only should use this code for CCM when the requirements for CPT codes 99490, 99487, 99491 or 99484 are met.

Note on RPM additional billing:

According to CMS multi-specialties can bill 99457 and 99454 on a patient for multiple chronic conditions by another provider. For example an office that has a FP or Cardiologist monitoring for CHF could also bill again on the same patient under another provider such as an endocrinologist to monitor for diabetes.

Bill Multi Specialty

Check this box to include a percentage of multi-specialty billing ($123/month)

Percentage of Patients to Monitor under a separate provider

Potential Revenue Calculations

Gross total revenue based on the above calculations. Does not take into account operational costs.

Total Yearly Revenue based on RPM or CCM or Both

Check or Uncheck RPM CPT codes and CCM codes to see how this adjusts. (Time requirements 20 minutes RPM and 20 Minutes CCM)

One Time Revenue for One Time Setup Charges

A charge of $21 per patient for initial setup can be used when billing. This is a one time fee and does not figure into the recurring revenue calculation. This is the number of Eligible Opt-In patients multiplied by $21

Gross Revenue Minus 20% Co-Pay Collection Per Year

Gross Revenue Minus 20% Co-Pay. Per Year, excluding one-time setup code 99453. CMS states an office must attempt to collect a 20% co-pay per month per patient for RPM services.