How Much Can Your Practice Earn from RPM, CCM, PCM, BHI & TCM?
Estimate monthly and annual Medicare reimbursement across all five CMS care-management programs — adjusted for the state where your practice operates.
Practice Inputs
Enter the number of patients you plan to enroll in each program, and the state where your practice operates.
State-specific GPCI multipliers are applied to base CPT rates.
Patients with 2+ chronic conditions, 20+ min/month of non-face-to-face care.
Device-based monitoring with 16+ days of readings per 30-day period.
Single high-risk chronic condition needing focused, intensive management.
Behavioral health conditions integrated into primary care workflows.
Post-discharge coordination during the critical 30-day window.
California · 275 patients
Estimates use 2025 CMS national base rates adjusted by state GPCI multipliers. Actual reimbursement varies by payer mix, documentation, and locality. Not financial advice.
The CPT Codes & National Base Rates We Use
Every projection in the calculator starts with the 2025 CMS national base rate for the program's primary CPT code, then applies the appropriate state-level GPCI multiplier.
| Program | Full Name | CPT Code(s) | National Base | Eligibility Note |
|---|---|---|---|---|
| CCM | Chronic Care Management | 99490 | $43 | 20+ min/month, 2+ chronic conditions |
| RPM | Remote Patient Monitoring | 99454 + 99457 | $100 | 16+ days of device readings / 30-day period |
| PCM | Principal Care Management | 99424 | $48 | Single high-risk chronic condition |
| BHI | Behavioral Health Integration | 99484 | $48 | Integrated behavioral health in primary care |
| TCM | Transitional Care Management | 99495 / 99496 | $220 | Post-discharge, 30-day window (one-time) |
Why Rates Vary State by State
CMS applies a Geographic Practice Cost Index (GPCI) to each service to reflect regional differences in physician work, practice expense, and malpractice cost. Two practices billing the same CPT code in different states can be reimbursed at meaningfully different rates.
The calculator simplifies this into four broad tiers and applies them automatically when you pick your state.
GPCI Multipliers Applied
| Tier | Multiplier | Examples |
|---|---|---|
| Low | 0.95× | AL, AR, KY, MS, OK, WV |
| Mid | 1.00× | AZ, FL, GA, MI, OH, TX |
| High | 1.10× | CA, IL, MA, NY, NJ, WA |
| Very High | 1.25× | AK, HI |
Project Your Revenue in Three Steps
Enter your patient mix
Tell us how many patients you plan to enroll in each program — CCM, RPM, PCM, BHI and TCM. You can update inputs at any time.
Pick your practice state
State selection automatically applies the correct GPCI multiplier to the national CPT base rate for each program.
See projected revenue
Monthly and annual reimbursement totals update instantly, with a per-program breakdown so you can compare each CMS opportunity.
About the Revenue Calculator
How are these revenue figures calculated?
Which CPT codes are used in the calculator?
Are these guaranteed reimbursement amounts?
Can CCM and RPM be billed for the same patient in the same month?
Does Circle Care handle the billing workflow?
Ready to Unlock This Revenue with Circle Care?
Our team will walk you through an end-to-end implementation plan — eligibility, enrollment, care delivery, and billing — across every CMS program you choose to launch.