What would a monitoring program your practice bills actually earn?
Your panel, your payer mix, your numbers. Every assumption below is editable and every default is sourced.
gross Medicare revenue per enrolled patient per month when all monthly codes are met; the model below applies realistic compliance and collection rates.
CMS Physician Fee Schedule, national non-facility averages
of documented clinical time per patient per month required for 99457: our licensed staff performs and documents it under your general supervision
added staff: enrollment, devices, monitoring, and documentation are operated by BPHM
01 · Your practice
Practice profile
Replace defaults with figures from your panel report. Everything recomputes live.
Industry telephonic enrollment typically converts under 10%. Physician-prescribed enrollment, the model we operate, targets 30 to 40%. Default is set between them deliberately.
02 · Reimbursement
Reimbursement assumptions
Rates below are CMS national non-facility averages and vary by locality and payer. Verify current-year rates with your MAC.
03 · Program cost
BPHM service fee
Leave blank to see gross practice revenue. Enter your proposed rate to see net.
Results · live
Your practice, in numbers.
Net annual revenue per billing provider
Gross figure shown. Enter your proposed rate above to see net.
Avg collected revenue per enrolled patient per month
$73.84
Practice monthly gross collections
$18,459
Practice annual gross collections
$221,509
Annual BPHM program cost
—
Net annual revenue to the practice
$221,509
enter your proposed rate to see net
First-year one-time setup revenue (99453)
$4,180
Breakeven
— enter your proposed rate to compute breakeven.
Value-based care
In an ACO or Medicare Advantage risk arrangement? The same monitoring that generates fee-for-service revenue prevents the admissions that cost you shared savings. Ask us to model avoided-admission value for your contracts.
Model avoided-admission value →These are your numbers.
Send yourself the full model, share a link that opens preloaded with this exact scenario, or take the next step below.
Next step · Discovery call
Thirty minutes with our physician enablement team.
We map your patient panel, walk through the workflow, and answer billing questions.
Sources and methodology
CPT code rates
Defaults for 99453, 99454, 99457, and 99458 reflect CMS Physician Fee Schedule national non-facility averages. Verify current-year rates for your locality and MAC before contracting or billing.
Documentation requirements
- 99454 requires at least 16 days of physiologic data transmission within a 30-day period.
- 99457 requires at least 20 minutes of interactive communication with the patient or caregiver during the calendar month.
- Patient consent and an established treatment relationship are required prior to enrollment.
Billing and relationship
All claims are submitted under the practice's NPI. BPHM is not the billing provider and receives no payment from payors. Our fee is a service fee paid by the practice.
Model notes
This calculator is illustrative. It is not billing or legal advice. It should be validated with the practice's billing counsel and compliance officer before use in any pro forma or contract.
Every figure on this page recomputes live in your browser. No inputs are stored on our servers or transmitted anywhere.
BPHM RPM is a clinical service delivered by Better Place Health Management. It is not an insurance product.