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Medicare Care Management Comparison Tool

Compare CCM, Complex CCM, PCM, RPM, RTM, APCM, and the CMS ACCESS Model side by side. This tool highlights programs that may be relevant to explore — it isn't billing advice.

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Chronic Care Management (CCM)

Current

Pays clinical staff/practitioner time each month for care coordination outside of office visits, for patients with multiple chronic conditions.

Category
Time-Based Care Coordination
Key code(s)
99490, 99439, 99487, 99489
Patient population
2+ chronic conditions expected to last 12+ months (or until death), with significant risk of death, acute exacerbation/decompensation, or functional decline
Time threshold
20 min/month (base, 99490); +20 min increments (99439); 60 min/month for complex CCM (99487) with moderate/high-complexity medical decision-making
Typically furnished by
Clinical staff under general supervision of the billing practitioner
Read the CCM Guide CMS — Chronic Care Management Services (MLN909188)

Advanced Primary Care Management (APCM)

Current

Bundles elements of principal care management, transitional care management, CCM, interprofessional consultations, and e-visits into one flat monthly payment tied to a patient's chronic-condition tier.

Category
Bundled Monthly Payment
Key code(s)
G0556, G0557, G0558
Patient population
Tiered: G0556 (0-1 chronic condition), G0557 (2+ chronic conditions), G0558 (2+ chronic conditions and Qualified Medicare Beneficiary status)
Time threshold
None — no monthly time threshold to track or document; billing depends on the patient's tier, not minutes spent
Typically furnished by
Billing practitioner and care team, once per patient per month (only one provider may bill APCM for a given patient in a given month)
Read the APCM Guide CMS — Care Management Services overview

Principal Care Management (PCM)

Current

Pays clinical staff/practitioner time each month for managing a single high-risk chronic condition, rather than the multi-condition scope CCM covers.

Category
Time-Based Care Coordination
Key code(s)
99424, 99425, 99426, 99427
Patient population
One serious, high-risk chronic condition expected to last at least 3 months, posing significant risk of hospitalization, acute exacerbation, decompensation, or death
Time threshold
30 min/month (physician/QHP codes 99424/99425); 30 min/month (clinical staff codes 99426/99427)
Typically furnished by
Physician/qualified health professional (99424/99425) or clinical staff under general supervision (99426/99427)
Read the PCM Guide CMS — Care Management Services overview

Remote Patient Monitoring (RPM)

Current

Uses connected devices to collect a patient's physiologic data (blood pressure, weight, glucose, pulse oximetry, etc.) between visits, with clinical staff time paid for reviewing and managing that data.

Category
Device-Based Monitoring
Key code(s)
99453, 99454, 99457, 99458
Patient population
Any patient for whom the treating provider determines physiologic monitoring is clinically appropriate — commonly hypertension, diabetes, weight management, and other chronic conditions
Time threshold
One-time setup (99453); recurring 30-day device-supply/data period (99454); 20 min/month treatment management with 1+ interactive communication (99457); +20 min increments (99458)
Typically furnished by
Clinical staff under general supervision; requires an interactive communication with the patient (or caregiver) for treatment-management codes
Read the RPM Guide CMS — Telehealth & Remote Monitoring (MLN901705)

Remote Therapeutic Monitoring (RTM)

Current

Medicare's billing pathway for monitoring a patient's response to a therapeutic treatment — musculoskeletal or respiratory status, therapy adherence, and self-reported data — as distinct from RPM's physiologic-signal focus.

Category
Device-Based Monitoring
Key code(s)
98975, 98976, 98977, 98980, 98981
Patient population
Patients receiving therapeutic treatment where monitoring response, adherence, or self-reported status is clinically useful (e.g., musculoskeletal or respiratory therapy programs)
Time threshold
One-time setup and recurring device-supply codes (98975/98976 or 98977); 20 min/month treatment management (98980); +20 min increments (98981)
Typically furnished by
Clinical staff, physicians, and other qualified health professionals; billed by practitioners who can bill Medicare for therapy/general medical services
Read the RTM Guide CMS — Telehealth & Remote Monitoring (MLN901705)

CMS ACCESS Model (ACCESS)

Current (model is live)

A 10-year CMMI payment model (started July 2026) organized around specific clinical tracks rather than general chronic-condition eligibility, combining an Outcome-Aligned Payment to a participating organization with a separate co-management payment to the primary care provider.

Category
Value-Based / Model Pilot
Key code(s)
G0676, G0677, G0678
Patient population
Patients matching one of ACCESS's clinical tracks (eCKM, CKM, MSK, BH at initial launch; more tracks added starting April 2027) — narrower and model-specific, not general chronic-condition eligibility like CCM
Time threshold
N/A — model uses Outcome-Aligned Payments and per-service co-management payments rather than a monthly minute threshold
Typically furnished by
Participating ACCESS organizations (Outcome-Aligned Payment) plus the primary care provider (co-management payment, up to 3x per 12-month period, plus a one-time onboarding add-on)
Read the ACCESS Guide CMS Innovation Center — ACCESS Model

How to Use This Comparison

Each card summarizes one Medicare care management program's category, billing codes, typical patient population, time threshold (if any), and who typically furnishes it. Filter by category to narrow the list, then open a program's dedicated guide for full eligibility, consent, documentation, and billing-requirement detail. This tool describes structural differences between programs — it does not recommend a specific program for a specific patient or practice.

Time-Based vs. Bundled vs. Device-Based vs. Model-Based

CCM and PCM pay for clinical staff/practitioner time against a monthly minute threshold. APCM replaces that time-tracking with a flat monthly payment tied to a patient's chronic-condition tier. RPM and RTM add device-based data collection to the picture, with their own setup, device-supply, and treatment-management codes. The CMS ACCESS Model is different in kind — a 10-year CMS Innovation Center payment model organized around specific clinical tracks, combining an Outcome-Aligned Payment to a participating organization with a separate co-management payment to the primary care provider.

Programs Can Overlap — Carefully

Several of these programs have explicit rules about combining them for the same patient in the same month (for example, RPM and RTM can't both be billed for the same patient at once, and multiple programs prohibit double-counting the same clinical time). Always confirm current combination rules against each program's dedicated guide and current CMS guidance before billing more than one program for the same patient.

Frequently Asked Questions

No. This tool compares structural characteristics of each Medicare care management program so you can identify programs that may be relevant to explore further with your billing and compliance team. It isn't billing advice and doesn't evaluate any specific patient.

Some combinations are allowed and some aren't — for example, RPM and RTM can't be billed together for the same patient in the same month, and several programs have same-time-cannot-be-double-counted rules with CCM. See each program's dedicated guide (linked from every row) and current CMS guidance before combining programs.

To keep this comparison accurate and avoid duplicating figures that can change, use the dedicated CCM Revenue Calculator and RPM Revenue Calculator for revenue estimates, and each program's reimbursement guide for current payment-amount detail.

It means CMS has published a proposed rule affecting that program for calendar year 2027 that has not yet been finalized. Current rules remain in effect until a final rule is published. See the linked guide for detail on the specific proposal.

No. CCM is a general chronic-condition care-coordination billing pathway open to any qualifying patient. The ACCESS Model is a CMS Innovation Center payment model organized around specific clinical tracks, with a different payment structure (Outcome-Aligned Payments plus a separate co-management payment).

Running (or planning) more than one care management program?

ChronicSync helps practices manage enrollment, care plans, documentation, and reporting across multiple Medicare care management programs in one place.

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