M15 · CCM · APCM · TCM

Care management programs

Combined view of CMS chronic care management (CCM), advanced primary care management (APCM), and transitional care management (TCM) populations and capture.

May 2026 · all programs

412 enrolled

across CCM, APCM, and TCM · $184,720 billable MTD · 71% capture vs. eligible cohort

CCM

Chronic Care Mgmt

186

99490, 99439, 99487, 99489

$71,400 MTD

APCM

Advanced Primary Care

182

G0556 · G0557 · G0558

$98,420 MTD

TCM

Transitional Care

99495 · 99496

$14,900 MTD

All programs

CCM only

APCM only

TCM only

Period · May 2026 (MTD)

CMS code capture 2026 national rates · physician fee schedule

View by complexity tier ↓

CPT/HCPCS

Description

Threshold

Rate

Pts billed

Capture vs eligible

MTD revenue

99490

CCM · base 20 min

CCM 2+ chronic conditions, expected ≥ 12 mo

≥ 20 min/mo clinical staff

$62

154

154 / 19778%

$9,548154 × $62

99439

CCM · +20 min add-on

CCM additional 20 min same calendar mo

+ 20 min ea., max ×2

$47

98 / 15464%

$4,60698 × $47

99487

Complex CCM · base 60 min

CCM moderate-high complexity MDM

≥ 60 min/mo clinical staff

$132

31 / 7442%

$4,09231 × $132

G0556

APCM · Level 1 (1 chronic)

APCM 1 chronic condition · all-in monthly

No time threshold

$15

38 / 4388%

$57038 × $15

G0557

APCM · Level 2 (≥ 2 chronic)

APCM 2+ chronic conditions · all-in

No time threshold

$50

96 / 11981%

$4,80096 × $50

G0558

APCM · Level 3 (QMB / dual)

APCM QMB-eligible, ≥ 2 chronic

No time threshold

$110

48 / 7267%

$5,28048 × $110

99495

TCM · moderate complexity

TCM contact w/in 2 biz days · visit ≤ 14d

14-day post-discharge

$201

28 / 3874%

$5,62828 × $201

99496

TCM · high complexity

TCM contact ≤ 2 biz days · visit ≤ 7d

7-day post-discharge

$282

16 / 2759%

$4,51216 × $282

Eligibility funnel · all programs

Medicare panel1,847

1,847 lives

≥ 1 chronic condition1,402

1,402

Eligible (CCM/APCM/TCM)578

578

Consented478

478

Billed this period412

412

166 patients lost between eligible → billed. Top reasons: missing consent (62), insufficient time (47), QMB attestation pending (28), discharge gap (29).

Movement · 30 days

New enrollments

consent + first contact

+47

▲ 12 vs prev 30d

CCM → APCM upgrades

complexity tier change

+18

▲ 6

TCM → CCM transitions

post-discharge handoff

+22

▲ 3

Disenrolled

death, opt-out, lost coverage

−14

▼ 4 better than prev

Net population

end of period

412

+33 net

Program comparison

	CCM	APCM	TCM
Time threshold	≥ 20 min	none	visit + contact
Cadence	monthly	monthly	post-DC
Consent required	✓	✓	implied
Care plan req	✓	✓	✓
QHP types	Phys, NPP	Phys, NPP	Phys, NPP
Avg rev / pt / mo	$110	$54	$222
Concurrent w/ BHI	✓	✓	×
Concurrent w/ RPM	✓	✓	✓

CloudCare reads the patient's enrollment + condition mix and surfaces the program with the highest expected per-patient yield. APCM defaults to Level 2 for any patient with 2+ chronic conditions unless QMB attestation triggers Level 3.