Key Revenue Opportunities
CCM Only
99490 - Non-complex clinical staff
$726
per patient/year
RPM Core
99454 + 99457 - Device & management
$1,092
per patient/year
CCM + RPM Bundle
Most common high-value combination
$1,818
per patient/year
Complete Package
AWV + CCM + RPM
$1,978
per patient/year
Revenue Potential by Patient Volume
Based on CCM + RPM bundle ($1,818/patient/year) with 50% participation rate
Quick ROI Calculator
Estimated Annual Revenue
$909,000
Based on 500 engaged patients
Annual Wellness Visit
Preventive health assessment and planning
Chronic Care Management
Coordinated care for chronic conditions
Remote Patient Monitoring
Continuous health data tracking
Transitional Care Management
Care coordination post-discharge
Service Details & Requirements
| Service | Code | Rate | Billing Basis | Requirements |
|---|---|---|---|---|
| AWV - Initial | G0438 | $160.44 | Once per beneficiary | First AWV for Medicare beneficiaries |
| AWV - Subsequent | G0439 | $126.47 | Once every 12 months | Follow-up annual wellness visits |
| CCM - Non-complex | 99490 | $60.49/month | Monthly | ≥20 min clinical staff time, 2+ chronic conditions |
| CCM - Complex | 99487 | $131.65/month | Monthly | ≥60 min + moderate/high MDM |
| RPM - Device Supply | 99454 | $43/month | Monthly | ≥16 days of data in 30 days |
| RPM - Management | 99457 | $48/month | Monthly | 20 min data review + communication |
| TCM - Moderate | 99495 | $201/episode | Per 30-day episode | Contact ≤2 biz days, visit ≤14 days |
| TCM - High Complexity | 99496 | $269/episode | Per 30-day episode | High-complexity MDM, visit ≤7 days |
Simulation Parameters
Cost Considerations
ROI Analysis Results
Annual Revenue
$909,000
Annual Costs
$315,000
Net Profit
$594,000
Revenue Breakdown
Cost Breakdown
Key ROI Metrics
ROI Percentage
189%
Break-even Period
4.2 months
Revenue per Patient
$1,818
Profit per Patient
$1,188
Sensitivity Analysis
Explore how changes in key parameters affect your ROI
Conservative
Low-risk implementation with minimal upfront investment
Moderate
Balanced approach with standard service mix
Aggressive
Full implementation with high participation goals
Scenario Comparison
Implementation Roadmap
Phase 1: Foundation (Months 1-3)
Implement AWV and basic CCM services. Train staff on documentation and billing requirements.
Phase 2: Expansion (Months 4-6)
Add RPM services and increase patient participation. Implement technology solutions for remote monitoring.
Phase 3: Optimization (Months 7-12)
Integrate TCM services, optimize workflows, and scale participation rates. Analyze ROI and adjust strategy.