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Coordinate with the treating practice while keeping agency services and professional care-management work distinct.
Begin with the home-health plan of care, existing agency services and treating practitioner’s responsibilities. Review whether proposed support adds distinct, necessary care rather than repeating existing work.
Current home-health episode and plan of care.
Explore documentation, revenue-cycle and agreed staffing support around your existing care model.
Agency, practitioner and outside-team tasks and documentation.
Do not treat the agency’s episode payment and a practitioner’s possible Part B claim as interchangeable revenue. Review coverage and duplication first; model each organization’s own payment route.
Validate the specific service, payer and arrangement before forecasting additional revenue.
Scenarios to evaluate—not approvals to bill or revenue guarantees.
Do not treat the agency’s episode payment and a practitioner’s possible Part B claim as interchangeable revenue. Review coverage and duplication first; model each organization’s own payment route.
Check enrollment, the exact service, stay dates, place of service and existing services. A Part A stay and care after discharge are different situations.
MEDICARE RATE REFERENCES · OCTOBER–DECEMBER 2026
Choose from all 58 California counties and nine program families. The lookup lists 41 active, nationally priced PFS codes, including alternatives and add-ons. It is a code-family reference, not a suggested claim or a complete Medicare code catalog.
How to use: choose county, program and rate setting. Amounts update automatically below; no submit button is needed. 2027 final-rule changes are explained separately; these amounts apply to October–December 2026.
6 codes shown. Base, alternative and add-on rows serve different purposes. Add-ons require their applicable primary service; alternatives are not a list to stack. See each program guide before using a rate.
Office / non-facility: the practitioner’s fee generally includes office-type overhead, such as staff, supplies and equipment.
Hospital / facility: the practitioner’s professional fee generally reflects that an institution bears some overhead. This is not the hospital’s or nursing home’s own payment.
The applicable rate depends on Medicare’s place-of-service rules and the particular service—not simply whether your organization calls itself a facility. Nursing-home residents can have different claim settings; do not select “facility” solely because the patient lives in a nursing home. Confirm the actual setting with your biller or Medicare contractor. Selecting a rate does not establish coverage.
CMS explanation of professional fees and practice expense →CMS locality: SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) · MAC 01112 · locality 05
A building name does not determine the claim’s place of service. A facility rate does not establish that a code is billable during an inpatient or Part A SNF stay.
| Code, role and plain-English service | Medicare allowed amount | Illustrative Medicare portion | Standard 20% cost share |
|---|---|---|---|
| CCM · 99490Base Clinical-staff CCM, first 20 minutes | $80.42 | $63.0580%, then 2% sequestration | $16.08Not automatically collectible |
| CCM · 99439Add-on Clinical-staff CCM, each additional 20 minutes | $62.10 | $48.6980%, then 2% sequestration | $12.42Not automatically collectible |
| CCM · 99487Alternative Complex CCM, first 60 minutes and required decision-making | $180.13 | $141.2280%, then 2% sequestration | $36.03Not automatically collectible |
| CCM · 99489Add-on Complex CCM, each additional 30 minutes | $97.38 | $76.3580%, then 2% sequestration | $19.48Not automatically collectible |
| CCM · 99491Alternative Practitioner-personal CCM, first 30 minutes | $107.00 | $83.8980%, then 2% sequestration | $21.40Not automatically collectible |
| CCM · 99437Add-on Practitioner-personal CCM, each additional 30 minutes | $76.19 | $59.7380%, then 2% sequestration | $15.24Not automatically collectible |
The allowed amount is a fee-schedule reference, not guaranteed collections. The Medicare portion assumes the deductible is met, assigned claims and no other adjustments. For a $100 allowed amount, the standard split is $80 Medicare and $20 cost sharing; 2% sequestration reduces Medicare’s $80 to $78.40.
Secondary insurance, Medicaid crossover, deductible status and claim-level adjustments change actual collections. QMB patients cannot be billed Medicare cost sharing even when Medicaid pays nothing. Medicare Advantage and commercial rates depend on the actual plan and contract. The higher QP conversion factor is not modelled here.
Patient cost-share guide →Verified against CMS October RVUs and GPCIs (RVU26D), October payment revisions, and the annual California carrier file: 2378 locality/code/setting comparisons. Effective 2026-10-01 through 2026-12-31. This excludes contractor-priced RTM code 98978 and plan-specific Part D MTM payments, which have no universal PFS amount. Descriptions are plain-language summaries, not full coding instructions. CMS source release. Requirements and sources.
This public lookup covers California only. Do not apply these amounts to Florida or another state. A rate reference is not a facility revenue estimate.
Define outreach, documentation, staffing and billing handoffs around your existing care. Clinical decisions remain with the responsible professionals.
Service hours, review cadence, urgent contacts and after-hours responsibilities are agreed before enrollment. PrimeVital does not promise continuous device surveillance or a 24/7 nurse line on this website. Emergency symptoms require emergency services, not waiting for routine monitoring review.
No upfront pilot fee; service fees are paid from collections under the written agreement. Confirm fees, timing and insufficient-collection terms before launch.
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