ACCESS Program
Medicare Fee-for-Service Chronic Disease Management
How It Works
MSO/IPA Joins
Organization submits intake form with physician count, NPI, Medicare FFS patients, chronic condition volumes.
Patients Enrolled
20-30% of patients qualify based on 10 chronic conditions. Enrolled via doctor office activation (QR codes, staff).
PMPM Revenue Flows
$15-22 per member per month. Doctor gets PMPM + quality bonuses + app revenue share. We earn $12 PMPM. RPM/CCM billing stacks on top separately.
Ten Target Conditions
| Condition | ICD-10 Codes | Prevalence |
|---|---|---|
| Hypertension | I10-I16 | ~45% of Medicare |
| Diabetes | E8-E13 | ~27% |
| Dyslipidemia | E78.x | ~44% |
| Obesity | E66.x | ~40% |
| Prediabetes | R73.x | ~33% |
| CKD (non-ESRD) | N18.x | ~15% |
| Cardiovascular | I25.x | ~12% |
| Chronic Pain | G89, M54, M25 | ~20% |
| Depression | F32-F34 | ~17% |
| Anxiety | F40-F43 | ~15% |
Billing Crosswalk Summary
Allowed
- +Office visits (99202-99215)
- +Preventive care (99381-99397)
- +Hospital care (99221-99239)
- +BH Treatment (90791-90837)
- +Screenings (G0444, G0396-G0397)
Not Allowed
- ×CCM (99490, 99487, 99491)
- ×Complex CCM (99489, 99437)
- ×Principal care mgmt (99424-99427)
- ×BH integration (99484, 99492-99494)
Reason: Duplicative of ACCESS coordination
Conditional
- RPM (99453-99458)Depends on overlap with ACCESS
- Transitional care (99495-99496)Depends on ACCESS bundle
Important: RPM/CCM billing is SEPARATE from ACCESS — it stacks on top as additional back-office revenue. The crosswalk above applies to ACCESS-funded coordination only. RPM codes can be billed independently when properly documented.
PMPM Revenue Calculator
Qualifying Patients
125
Monthly Revenue
$2,375
Annual Revenue
$28,500
Our Revenue ($12 PMPM)
$1,500/mo
Doctor Revenue ($15-22 PMPM)
$2,375/mo
+ RPM/CCM Back Office
Stacks on top
ACCESS is EPC/CM only. For full product flexibility (DPC, concierge, cash-pay), target the private employer market where there are zero billing restrictions.