APCM vs CCM Revenue Calculator | Transition Financial Modeler
Compare annual revenue between CCM and the new APCM model. Model your risk-stratified patient panels and see the financial impact of transitioning.
Transitioning from time-based CCM to risk-stratified APCM requires a fundamental shift in financial modeling. This calculator helps you compare your current CCM revenue against projected APCM earnings based on your patient risk distribution and the elimination of manual time-tracking overhead.
Your Numbers
Number of patients currently enrolled in Chronic Care Management programs.
Your average monthly reimbursement per patient (typically ~$62 for 99490).
Patients with one or no chronic conditions qualifying for APCM Level 1 (G0551).
Patients with two or more chronic conditions qualifying for APCM Level 2 (G0552).
High-risk patients or those with social determinants of health needs (G0553).
Estimated yearly revenue under the traditional CCM time-based model.
Projected yearly revenue using the new APCM risk-stratified tiers.
The difference in total annual revenue between the two programs.
How this calculator works
We calculate your current CCM annual revenue and compare it against the three-tiered APCM reimbursement structure (Level 1, 2, and 3) using 2026 Medicare national averages. The model accounts for the removal of the 20-minute minimum requirement in favor of a flat monthly fee per attributed patient.
Assumptions- Calculations use 2026 Medicare national average non-facility payment rates.
- Assumes 100% of current CCM patients are successfully transitioned to an appropriate APCM tier.
- Does not account for sequestration or geographic practice cost indices (GPCI) adjustments.
- Assumes no concurrent billing of CCM and APCM for the same patient in the same month.
Frequently Asked Questions
No, CMS prohibits billing APCM (G0551-G0553) and CCM (99490, 99491) for the same patient in the same calendar month.
Unlike CCM, which requires a minimum of 20 minutes of staff time, APCM is a monthly bundled payment based on patient risk, significantly reducing administrative burden.
Levels are determined by the number of chronic conditions and social risk factors, with Level 1 for low risk, Level 2 for moderate, and Level 3 for high-complexity patients.
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