How much Medicare care-management revenue is your health center leaving unclaimed?
Roughly 23 million Medicare beneficiaries qualify for chronic care management. About 4% are served. That gap is worth $8B+ a year in unclaimed reimbursement (industry estimates) — and after the G0511 sunset, every FQHC claims its share code by code, or not at all.
Your panel
Adjust to your health center. Every assumption is labeled below the results.
APCM G0557 for non-duals — lower rate per patient, but no time threshold: coordinator caseloads run ~1:250–400 and below-threshold months never bill $0.
Total Medicare (incl. dual) patients attributed to your center.
Duals route to APCM G0558, which removes the coinsurance barrier for QMB patients.
Default 4% — the national CCM uptake among eligible beneficiaries (JAGS 2024).
What a dedicated navigator team typically reaches. Capped at 60% of eligible.
Based on 704 newly enrollable patients — 67% of your panel with 2+ chronic conditions (CMS chartbook estimate) × the enrollment gap you set.
Breakdown by code
| Code | Patients | Rate / mo | Monthly | Annual |
|---|---|---|---|---|
G0558 · APCM Dual-eligible / QMB share | 211 | $117.23 | $24,741 | $296,897 |
G0557 · APCM 2+ chronic, non-dual | 492 | $53.77 | $26,479 | $317,748 |
| Total unclaimed | 704 | $51,220 | $614,645 |
CY2025/26 Physician Fee Schedule non-facility approximations — CCM 99490 $66.30 base plus add-ons, CHI/PIN G0019/G0023 ≈ $78 blended, APCM G0557 $53.77 / G0558 $117.23 (2026). Duals route to APCM G0558 under both strategies (QMB coinsurance can't be collected, which is what historically killed dual CCM enrollment). Verify exact rates against your MAC.
With a full-service partner at $60 per enrolled patient / month
Flat per-member FMV fee, set in advance — never a share of collections. Illustrative; final rate card is set in your agreement.
The partner supplies and manages the navigator workforce — your health center bears no staffing cost. Your billing team submits the claims; you keep the margin.
Have the actual panel file? Get a patient-by-patient eligibility and revenue map — computed in your browser, nothing uploaded.
Open the Panel ScannerWhy this revenue is claimable now.
Three rule changes turned care management from a staffing headache into a billable program.
The bundled care-management code is gone. FQHCs now bill the individual codes — CCM 99490, CHI G0019, PIN G0023, APCM G0558 — at Physician Fee Schedule non-facility rates. Centers that never built the program are leaving the line items blank.
For QMB dual-eligibles, coinsurance can't be collected from the patient — which historically killed CCM enrollment. APCM G0558 addresses this for your dual population, which is why the calculator routes your dual share to it.
CMS auxiliary-personnel rules (42 CFR 410.26) allow contracted community-based staff to perform care-management services under general supervision. You don't have to hire the navigators — a partner can supply them, and the billing stays yours.
You bill it. We run it.
IHA runs the entire program — trained navigators, AI-powered care operations, audit-ready billing packets — for a flat per-patient fee. Your billing team submits; you keep the margin.
Built to bill cleanly. Partner fees are flat, fair-market-value per-patient amounts — never a percentage of collections, per OIG guidance. Every enrolled patient gives one-time, documented consent before services begin. All rates shown are CY2025 PFS non-facility approximations for estimation only — verify against your Medicare Administrative Contractor before budgeting.