The Long-term Enhanced ACO Design (LEAD) Model was announced by the CMS Innovation Center in December 2025. LEAD will launch January 1, 2027, at the conclusion of the ACO REACH ...
ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a voluntary, 10-year payment model from the CMS Innovation Center that begins July 5, 2026, and runs through ...
Beginning in CY 2026, CMS uses two separate national conversion factors for the first time, as required by statute: Qualifying APM Conversion Factor: $33.5675 (a +3.77% increase ...
CPT Code | Description | 2026 National Average (Approx.): | 99484 | General BHI, at least 20 min clinical staff time per month | ~$55 | | 99492 | CoCM, first 70 min in first ...
CPT Code | Description | 2026 National Average (Approx.): | 99424 | First 30 min, physician/QHP time | ~$89 | | 99425 | Each additional 30 min, physician/QHP time (add-on to ...
The following are approximate national average reimbursement rates for APCM services effective January 1, 2026. HCPCS Code | Level | Patient Population | 2026 National Average: | ...
The following are approximate national average reimbursement rates for RPM services effective January 1, 2026. Device Supply and Setup Codes: CPT Code | Description | 2026 ...
The following are approximate national average non-facility reimbursement rates for CCM services effective January 1, 2026, under the CY 2026 Medicare Physician Fee Schedule. ...
A Relative Value Unit (RVU) is a numerical measure assigned to each medical service under the Medicare Physician Fee Schedule, representing the relative resources required to ...
A Qualified Medicare Beneficiary (QMB) is a Medicare beneficiary who qualifies for Medicaid assistance with Medicare Part A and Part B premiums, deductibles, copayments, and ...
Connected care depends on a technology ecosystem that includes remote monitoring devices, care management software platforms, electronic health record (EHR) systems, ...
*This section describes chronic conditions commonly addressed through connected care programs. The information is provided in the context of why connected care services are ...
Current Procedural Terminology (CPT) codes are a standardized system of medical billing codes maintained by the American Medical Association (AMA). Providers use CPT codes to ...
Telehealth refers to the delivery of health care services using real-time audio and video communication between a patient at one location (the originating site) and a provider at ...
Value-based care is a health care delivery and payment framework that ties provider reimbursement to the quality and efficiency of care rather than the volume of services ...
The Medicare Physician Fee Schedule (MPFS or PFS) is the system CMS uses to determine how much it pays physicians and other practitioners for services covered under Medicare Part ...
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services (HHS) responsible for administering Medicare, ...
Behavioural Health Integration (BHI) is a Medicare service category that reimburses providers for non-face-to-face care management of patients with mental, behavioural health, or ...
Principal Care Management (PCM) is a Medicare Part B service that provides reimbursement for the management of patients with a single, complex chronic condition. Where CCM ...
Advanced Primary Care Management (APCM) is a Medicare care management service that became effective January 1, 2025, under the CY 2025 Physician Fee Schedule final rule. APCM ...
Remote Patient Monitoring (RPM), also called remote physiologic monitoring, is a Medicare service that allows health care providers to collect and review physiologic data from ...
Chronic Care Management (CCM) is a Medicare Part B benefit that reimburses eligible billing practitioners for non-face-to-face care coordination and management services provided ...
Connected care describes a model of health care delivery that uses communication technologies, remote monitoring devices, and structured care coordination to extend the clinical ...
