The CMS ACCESS Model launched in July 2026. See how the new co-management payments, G-codes, and care-coordination rules work for referring physicians.
Medicare has a new tool for chronic disease management. It changes how referring physicians get paid for coordinating care outside the exam room.
In July 2026, CMS officially opened the ACCESS Model - Advancing Chronic Care with Effective, Scalable Solutions - to eligible beneficiaries with traditional Medicare. It's a 10-year Innovation Center pilot. The bet is simple: if digital health tools and outcome-based payments keep chronic-condition patients healthier, Medicare should pay for the results, not just the visits.
For practices already running chronic care management or remote patient monitoring programs, ACCESS isn't a competitor. It's another lever in the same value-based care shift we've tracked before, including the CMS 2026 RTM reimbursement increase and the move toward outcome-driven chronic care models.
What is ACCESS in one minute?
What the ACCESS Model Actually Does
Roughly 200 organizations were accepted into the first ACCESS cohort - digital therapeutics companies, wearable makers, and behavioral health platforms among them. They enroll Medicare patients directly and deliver ongoing, tech-enabled support for conditions CMS says affect nearly seven in ten Medicare beneficiaries, including:
- Hypertension
- Type 2 diabetes
- Chronic kidney disease
- Musculoskeletal pain
- Depression and other behavioral health conditions
The payment model is outcome-based. Participants are paid recurring amounts tied to whether a patient's health markers actually improve - blood pressure control, HbA1c, weight, pain scores - rather than per visit or per device shipped.
What they cannot do:
- Bill Medicare for individual encounters, tests, or procedures
- Replace the patient's existing physician relationships
That billing stays exactly where it is today - with the primary care physician or other treating clinicians. ACCESS organizations are supplemental, not a substitute for a patient's care team.
Which of My Patients are Eligible for ACCESS?
Eligibility runs through the patient's coverage and diagnosis, not through anything a referring physician needs to certify. A patient generally qualifies if they:
- Are enrolled in original (traditional) Medicare - Medicare Advantage enrollees are not eligible for this model
- Have a documented diagnosis on at least one of the qualifying condition tracks (hypertension, type 2 diabetes, chronic kidney disease, chronic musculoskeletal pain, or a covered behavioral health condition)
- Are willing to enroll directly with a participating ACCESS organization
CMS estimates close to seven in ten Medicare beneficiaries meet the criteria for at least one track, given how common these chronic conditions are in the Medicare population. A single patient can also qualify for more than one track at a time - for example, hypertension and depression - and enroll in both.
The referring physician doesn't need to screen for eligibility or submit anything to confirm it. The ACCESS organization handles enrollment and verifies eligibility on its end. The physician's role starts once a shared patient shows up in the coordination workflow - reviewing updates and billing the co-management payment where applicable.
Who's Actually Running These Programs
The first ACCESS cohort brings together a mix of digital health names, some more familiar to patients than others. Companies confirmed as participants include Alyka Health, Headspace, Liza Health, Noom, Weight Watchers, and Withings - spanning behavioral health, weight management, and connected-device categories.
That range matters for care teams. A patient referred into ACCESS could end up working with a meditation app, a weight-loss platform, or a remote-monitoring device maker, depending on which condition track they qualify for. Knowing that upfront helps set expectations when patients ask what "ACCESS" actually is.
CMS has also said the model has executive-level backing on both sides: CMS Innovation Center leadership has framed ACCESS as a way to bring proven digital tools into everyday chronic care, and physician groups have generally welcomed the outcome-based structure as a step toward paying for results rather than service volume.
Compliance & Oversight: What CMS Requires of ACCESS Organizations
Because these are non-physician organizations receiving Medicare payments, CMS built in guardrails that referring physicians should be aware of:
- Regulatory compliance. Every ACCESS participant must meet HIPAA privacy and security requirements, applicable FDA rules for any device or software involved, and relevant state and federal licensure requirements.
- A physician clinical director. Each participating organization is required to designate a physician clinical director, even though that organization can't bill for individual physician services.
- Ongoing CMS monitoring. Participants are subject to continuous oversight for quality, safety, and outcome performance - not a one-time approval and then silence.
- Public outcome reporting. Starting in winter 2028, CMS plans to publish risk-adjusted outcomes for each participating organization, giving referring physicians a way to compare performance before choosing where to send future referrals.
For practices that want the details straight from the source, CMS maintains a dedicated resource page answering physician-specific questions about referrals, billing, and coordination - worth bookmarking alongside your practice's own chronic care management resources.
The Part That Affects Your Billing: Co-Management Payments
This is the detail most referring and primary care practices will feel directly. CMS created a new co-management payment for physicians who coordinate with an ACCESS organization on a shared patient's care.
- No enrollment required: Any Medicare Part B–enrolled physician can refer a patient and bill the payment without applying to the model.
- What triggers payment: Reviewing a structured care update and completing one related coordination task - a medication adjustment, problem-list update, or referral.
- Standard rate: $30 per service, adjusted geographically, plus a one-time $10 add-on for the first onboarding assist per patient.
- Frequency limits: Up to three payments per patient, per ACCESS track, per 12-month care period. Multiple tracks can be billed separately if the coordination work is distinct.
- New codes: G0676 (hypertension, type 2 diabetes, chronic kidney disease and related conditions), G0677 (chronic musculoskeletal pain), G0678 (behavioral health).
Everything else about existing Medicare billing is unaffected. For practices already tracking time-based work under CCM, RPM, or PCM care management service programs, this will feel familiar - a structured, code-specific pathway layered on top of standard fee-for-service work.
How Care Coordination Data Will Reach You
ACCESS organizations must send structured updates to the referring or primary care physician at three points:
- At care initiation
- At any clinical escalation
- At the end of each care period
Updates travel through HIPAA-compliant channels: Direct Secure Messaging, network-based push tools, or compliant electronic fax.
By July 2027, every ACCESS organization must connect to a CMS Aligned Network, Health Information Exchange, or comparable trusted network. In practice, that means blood pressure, HbA1c, LDL-C, weight, patient-reported outcomes, and medication data should eventually surface inside the EHR workflows practices already use - echoing the interoperability push behind connected remote patient monitoring workflows.
Why This Matters Beyond the Billing Codes
ACCESS is another signal that CMS is paying for chronic disease outcomes, not volume - the same direction behind recent RTM reimbursement changes and the broader shift covered in our industry insights.
Two quick takeaways for practices:
- If you already have a structured chronic care infrastructure - documented care plans, coordinated messaging, outcome tracking - ACCESS coordination should add minimal friction.
- If you don't, ACCESS coordination may become another manual task competing for physicians' time.
Expect patients to arrive already enrolled with an ACCESS organization, sometimes with little advance notice. A simple internal process - who reviews incoming updates, who documents coordination activity, who submits the G-code claim - will save time later.
Conclusion
The ACCESS Model doesn't change how physicians treat their patients. It changes how Medicare pays for the coordination work already happening around chronic care. The co-management payment gives referring and primary care physicians a defined, billable way to stay engaged when a patient enrolls with an ACCESS organization, without adding a new enrollment burden or disrupting existing billing.
The practices best positioned to benefit are the ones that already treat chronic care coordination as a structured, trackable process rather than an ad hoc one. Setting up that workflow now, before ACCESS patients start showing up in larger numbers, is the simplest way to capture the payment and keep care coordinated.
FAQ
What is the average monthly cost of RPM per patient?
The total cost of a Remote Patient Monitoring (RPM) program typically ranges from $150 to $300 per patient per month (PPPM), including connected devices, software, and clinical staffing. Platform-only software generally costs $80 to $200 PPPM.
Does Medicare reimburse enough to cover RPM costs?
In many cases, yes. Combined reimbursement from eligible RPM CPT codes can reach $120 to $200+ per patient per month. When RPM is billed alongside Chronic Care Management (CCM), total reimbursement may increase to $200 to $300+ PPPM, depending on documentation and billing compliance.
What's the highest hidden cost in an RPM program?
Clinical staffing is often the largest hidden expense. A fully loaded care manager typically costs $52 to $69 per patient per month at standard patient-to-staff ratios, which can exceed the cost of the RPM software platform itself.
Is it cheaper to build an in-house RPM platform or use a vendor?
For most healthcare organizations with smaller patient populations, vendor-provided RPM platforms are more cost-effective. Building an in-house platform requires substantial upfront investment but can reduce per-patient costs by 30–50% once enrollment exceeds approximately 1,000 patients.
What new CPT codes affect RPM pricing in 2026?
The introduction of CPT 99445 and CPT 99470 in 2026 provides greater billing flexibility by allowing reimbursement for 2–15 days of transmitted data and 10 minutes of treatment management time, replacing previous all-or-nothing billing thresholds.
Do cellular devices cost more than Bluetooth devices?
Yes. Cellular-enabled RPM devices typically cost $80 to $200+, while Bluetooth devices generally range from $30 to $100. However, cellular devices often achieve higher patient compliance because they automatically transmit data without requiring Wi-Fi or smartphone pairing.
Can RPM costs be offset by combining it with other care management programs?
Yes. Combining RPM with programs such as Chronic Care Management (CCM) can significantly increase reimbursement per patient without increasing the number of enrolled patients, making it one of the most effective strategies for improving RPM program return on investment (ROI).