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 ...
