Reimbursement Intelligence
Medicare vs. State Medicaid Reimbursement for RPM, CCM & TCM
A state-by-state planning center for remote patient monitoring, chronic care management, and transitional care management. Compare the Medicare framework with state Medicaid program and managed-care pathways without treating unverified legacy values as current policy.
Reimbursement policies change. State pages and legacy 2026 workbooks are re-audited against payer source material. A source audit is treated as current for no more than 180 days, with shorter source-specific windows when the billing authority updates more frequently; after the applicable window, the page automatically changes to a refresh-due status until the official source is checked again. A workbook is exposed only when the state-matched media attachment is registered and the actual XLSX file exists on disk; its values still require payer-source validation. Confirm current payer policy, fee schedules, contracts, and billing requirements before operational use.
Verified Medicare baseline
CY 2026 Medicare source check
CMS finalized the CY 2026 Physician Fee Schedule for services effective on or after January 1, 2026. CMS also confirms that Medicare broadly covers remote patient monitoring for acute and chronic conditions when program requirements are met. The 2026 RPM code set added CPT 99445 and 99470 for lower-day and lower-time monitoring scenarios, so older RPM lists that omit those codes are incomplete for 2026 planning.
Source status: CMS national Medicare policy checked August 30, 2026. State Medicaid and MCO policy remains state/plan specific and is audited separately.
Quarterly PFS timing safeguard
As of September 5, 2026, the service-date-appropriate 2026 Medicare release is July 2026 (RVU26C / PFREV26C). CMS updates PFS payment files quarterly, so use the release applicable to the actual date of service rather than simply the newest file posted.
The October 2026 RVU26D / PFREV26D files may already be posted, but they should not be used for dates of service before October 1, 2026. Beginning January 1, 2026, CMS also uses separate QP and non-QP PFS files because different conversion factors can apply.
RPM
Remote Patient Monitoring
Planning coverage for device setup, physiologic data transmission, treatment management, and interactive clinical time requires both code-level rules and payer-specific policy review.
Core 2026 code family: 99453, 99454, 99445, 99457, 99458, 99470, 99091
CCM
Chronic Care Management
CCM economics depend on eligible patients, documented care-planning workflows, staff time, supervision, code combinations, and whether a payer recognizes the Medicare-style benefit structure.
Core code family: 99490, 99439, 99491, 99437, 99487, 99489
TCM
Transitional Care Management
TCM requires coordinated post-discharge follow-up, timely interactive contact, and a qualifying face-to-face visit. Medicaid treatment can vary materially by state and plan.
Core code family: 99495, 99496
State selector
Choose your Medicaid market
Search by state name or abbreviation, use the quick jump, or browse the directory below. On larger screens, the interactive U.S. map provides an additional way to choose a market.
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How to use this intelligence
Separate national coding rules from state and plan policy
Medicare provides a national reference point, while Medicaid reimbursement can differ across fee-for-service programs, managed-care contracts, provider types, service settings, telehealth rules, and state-specific billing manuals. A strong business case therefore needs more than a single fee number.
Coverage
Is the service recognized for the relevant provider, patient, setting, and delivery model?
Billing rules
What time, device, interaction, care-plan, consent, and frequency requirements apply?
Payment
What fee schedule, facility methodology, encounter payment, or contract rate applies?
Contracting
If FFS is limited, is there an MCO, PMPM, value-based, quality, or programmatic pathway?
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