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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.

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Verification standard

Reimbursement policies change. State pages and legacy 2026 workbooks are being re-audited against payer source material. A workbook being present in the media library means the file was located, not that every value has been re-verified. 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.

CMS 2026 final rule CMS RPM guidance CMS PFS lookup

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

Click any state on the map, or choose a state or territory from the list.

AlabamaAL Source audited Workbook located AlaskaAK Source audited Workbook located ArizonaAZ Source audited Workbook located ArkansasAR Source audited Workbook located CaliforniaCA Source audited Workbook located ColoradoCO Source audited Workbook located ConnecticutCT Source audited Workbook located DelawareDE Source audited Workbook located FloridaFL Source audited Workbook located GeorgiaGA Source audited Workbook located HawaiiHI Source audited Workbook located IdahoID Source audited Workbook located IllinoisIL Source audited Workbook located IndianaIN Source audited Workbook located IowaIA Source audited Workbook located KansasKS Source audited Workbook located KentuckyKY Source audited Workbook located LouisianaLA Source audited Workbook located MaineME Source audited Workbook located MarylandMD Source audited Workbook located MassachusettsMA Source audited Workbook located MichiganMI Source audited Workbook located MinnesotaMN Source audited Workbook located MississippiMS Source audited Workbook located MissouriMO Source audited Workbook located MontanaMT Source audited Workbook located NebraskaNE Source audited Workbook located NevadaNV Source audited Workbook located New HampshireNH Source audited Workbook located New JerseyNJ Source audited Workbook located New MexicoNM Source audited Workbook located New YorkNY Source audited Workbook located North CarolinaNC Source audited Workbook located North DakotaND Source audited Workbook located OhioOH Source audited Workbook located OklahomaOK Source audited Workbook located OregonOR Source audited Workbook located PennsylvaniaPA Source audited Workbook located Puerto RicoPR Source audited No workbook verified Rhode IslandRI Source audited Workbook located South CarolinaSC Source audited Workbook located South DakotaSD Source audited Workbook located TennesseeTN Source audited Workbook located TexasTX Source audited Workbook located UtahUT Source audited Workbook located VermontVT Source audited Workbook located VirginiaVA Source audited Workbook located WashingtonWA Source audited Workbook located West VirginiaWV Source audited Workbook located WisconsinWI Source audited Workbook located WyomingWY Source audited Workbook located

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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