Revenue by billing code
Every service a medical practice bills carries a standard billing code, and each code pays its own amount. This build uses an invented remote care company and invented, rounded rates. Change the mix of programs, the days of readings and the minutes of staff time, and watch which codes bill, what each patient earns in a month and how much of it reaches the company.
What this shows
- Which codes bill for a patient in a month, and why two of them can never bill together
- Revenue per patient by program and by code, side by side
- The mix of public, commercial and patient-paid bills, and what is collected after denials
- The company's service fee as a share of what the practice collects
How I use it
- Estimating what a new patient is worth per month before a contract is signed
- Seeing which code carries the revenue and what happens if it is paid less
- Checking that a billing rule is not being counted twice
Explore the model below. It uses an invented company and invented numbers.
Explore the model
Illustrative model · Synthetic dataWide tables scroll sideways: swipe inside a table to see every column.
Sample build: revenue by billing code for an invented remote care company
Fernhollow Remote Care is an invented company that runs remote monitoring and chronic care programs for medical practices. The practice bills each patient each month, and Fernhollow earns a service fee on the cash the practice collects. Set up one patient's month, pick the mix of programs and see which codes bill, what each patient earns and how much reaches the company.
Invented company and invented inputs. Illustrative rates, not the fee schedule.
What to try
- Set the days of readings to 15, then 16. The device code changes from 99445 to 99454 and the month earns more.
- Move the management minutes from 19 to 20. The 10-minute code gives way to the 20-minute code.
- Clear the live two-way contact box. Treatment management stops billing, but device supply carries on.
- On the Rules tab, try to bill both codes in each pair. The second code is refused and no total moves.
- On the Revenue tab, pay 99457 30 percent less and read what it costs per patient and what the company loses.
Billed per patient a month
$108.58
At the illustrative rates
Collected per patient a month
$96.72
After payers, denials and patient balances
Company fee per patient
$11.61
12% of collected cash
Largest code
99457
30% of collected cash
Steady readings, one management call and some chronic care time, with a few minutes logged to both programs.
Minutes logged to both programs only matter for a patient in both. They count toward remote monitoring first, so chronic care bills on what is left. In this build a patient's care management minutes bill under one family of codes in a month.
Which codes bill, and why
Codes for remote monitoring only, per patient per month
- 99453Setup and patient educationOnce$1.67
Billed once per patient, so it is spread over the 12 months a patient stays enrolled.
- 99454Device supply, 16 or more daysBills$45.00
20 days of readings, and 16 or more earns this code.
- 99445Device supply, 2 to 15 daysNo-
16 or more days bills 99454 instead. Only one device code bills in 30 days.
- 99457Treatment management, first 20 minutesBills$50.00
30 minutes with a live two-way contact, and 20 earns this code.
- 99470Treatment management, first 10 minutesNo-
20 or more minutes bills 99457 instead. Only one of the two bills in a month.
- 99458Treatment management, each added 20 minutesNo-
No full 20-minute block after the first 20 (10 minutes extra).
- Average month, setup spread over the months enrolled$96.67
A steady month with no setup bills $95.00. The first month carries the whole setup and bills $115.00. These are the illustrative rates, before payers, denials and patient balances.
Codes for chronic care only, per patient per month
- 99490Chronic care, first 20 minutesBills$60.00
40 minutes, and 20 earns the first block.
- 99439Chronic care, each added 20 minutesBills$45.00
1 added block of 20 minutes after the first 20.
- 99484Behavioral health care managementNo-
Care manager minutes bill as general chronic care here.
- Average month, setup spread over the months enrolled$105.00
A steady month with no setup bills $105.00. The first month carries the whole setup and bills $105.00. These are the illustrative rates, before payers, denials and patient balances.
Codes for both programs, per patient per month
- 99453Setup and patient educationOnce$1.67
Billed once per patient, so it is spread over the 12 months a patient stays enrolled.
- 99454Device supply, 16 or more daysBills$45.00
20 days of readings, and 16 or more earns this code.
- 99445Device supply, 2 to 15 daysNo-
16 or more days bills 99454 instead. Only one device code bills in 30 days.
- 99457Treatment management, first 20 minutesBills$50.00
30 minutes with a live two-way contact, and 20 earns this code.
- 99470Treatment management, first 10 minutesNo-
20 or more minutes bills 99457 instead. Only one of the two bills in a month.
- 99458Treatment management, each added 20 minutesNo-
No full 20-minute block after the first 20 (10 minutes extra).
- 99490Chronic care, first 20 minutesBills$60.00
30 minutes (40 logged, less 10 shared minutes already counted for remote monitoring), and 20 earns the first block.
- 99439Chronic care, each added 20 minutesNo-
No full 20-minute block after the first 20 (10 minutes extra).
- 99484Behavioral health care managementNo-
Care manager minutes bill as general chronic care here.
- Average month, setup spread over the months enrolled$156.67
A steady month with no setup bills $155.00. The first month carries the whole setup and bills $175.00. These are the illustrative rates, before payers, denials and patient balances.
Monitoring only
$86.11
Billed $96.67
Chronic care only
$93.53
Billed $105.00
Both programs
$139.55
Billed $156.67
Blended
$96.72
Billed $108.58
Each figure is cash collected per patient per month after the payer mix, denials and patient balances. Setup is spread over the months a patient stays enrolled.
| Who pays | Cash | Share of cash |
|---|---|---|
| Public programs | $55.94 | 57.8% |
| Commercial payers | $26.37 | 27.3% |
| Patients | $14.41 | 14.9% |
| Collected cash | $96.72 | 100.0% |
Cash per patient per month, by program and code
| Code | Monitoring | Chronic care | Both | Blended | Share |
|---|---|---|---|---|---|
| 99453Setup and patient education | $1.48 | - | $1.48 | $0.96 | 1.0% |
| 99454Device supply, 16 or more days | $40.08 | - | $40.08 | $26.05 | 26.9% |
| 99445Device supply, 2 to 15 days | - | - | - | - | - |
| 99457Treatment management, first 20 minutes | $44.54 | - | $44.54 | $28.95 | 29.9% |
| 99470Treatment management, first 10 minutes | - | - | - | - | - |
| 99458Treatment management, each added 20 minutes | - | - | - | - | - |
| 99490Chronic care, first 20 minutes | - | $53.44 | $53.44 | $26.72 | 27.6% |
| 99439Chronic care, each added 20 minutes | - | $40.08 | - | $14.03 | 14.5% |
| 99484Behavioral health care management | - | - | - | - | - |
| Cash collected | $86.11 | $93.53 | $139.55 | $96.72 | 100.0% |
| Billed at the illustrative rates | $96.67 | $105.00 | $156.67 | $108.58 |
What if one code is paid less
Choose a code and a cut to see what it costs per patient per month. The cut is applied to the code in every program that bills it.
Why a second code in a pair is refused
Some codes are two versions of the same service. Device supply is 99454 when readings come on 16 or more of 30 days and 99445 when they come on 2 to 15 days. The first treatment management block is 99457 for 20 minutes and 99470 for 10 minutes. In each pair only one bills in the period, so a month never earns both. The same rule covers time: a minute of staff time counts for one program, never two.
Try to break the rules
The second code is added as a line, then refused. Nothing in the revenue totals moves.
Applies to patients in both programs, using the minutes logged to both on the Patient month tab.
What the rules did this month
- Device supply, one of 99454 and 99445
99454 bills (20 days of readings, 16 or more needed). 99445 cannot bill with it.
- Treatment management, one of 99457 and 99470
99457 bills (30 minutes). 99470 cannot bill with it.
- Minutes count once across both programs
Minutes logged to both programs: 10. They count toward remote monitoring, so chronic care bills on 30 of its 40 logged minutes.
Lines the rules refused
Nothing was refused. Switch on one of the two tests above to see a line added and then refused.
Other rules this build follows
- Treatment management has no days-of-data test. Device supply does. A month with few readings can still bill management.
- Added blocks (99458 and 99439) bill only after their first block, and only for each full 20 minutes.
- Only one practitioner can bill remote monitoring for a patient in a 30-day period.
- Remote monitoring needs an established relationship between the patient and the practice.
- Remote monitoring and chronic care can both bill for one patient in a month, as long as no minute counts twice.
Rules are simplified for illustration. Check current payer guidance before relying on any of them.
Collected cash
$96.72
Per patient per month, blended
Company fee
$11.61
12% of collected cash
Practice keeps
$85.11
Collected cash less the fee
Refused lines
$0.00
In none of the totals
From billed to what each side keeps
Per patient per month, blended across the program mix
- Billed at illustrative rates$108.58
The code lines for the current mix of programs.
- Allowed by payers$111.84
Public programs pay the rate and commercial payers pay 110% of it, which averages 1.030 times the rate.
- Left after denials$102.89
8.0% of billed lines are denied.
- Paid by payers$82.31
80% of what is left after denials.
- Owed by patients$20.58
20% of what is left after denials.
- Paid by patients$14.41
70% of patient balances are paid.
- Collected cash$96.72
Paid by payers plus paid by patients.
- Company fee$11.61
12.0% of collected cash.
- Practice keeps$85.11
Collected cash less the company fee.
| Program | Billed | Cash collected | Company fee | Practice keeps |
|---|---|---|---|---|
| Remote monitoring only | $96.67 | $86.11 | $10.33 | $75.77 |
| Chronic care only | $105.00 | $93.53 | $11.22 | $82.30 |
| Both programs | $156.67 | $139.55 | $16.75 | $122.80 |
| Blended | $108.58 | $96.72 | $11.61 | $85.11 |
The fee is a share of cash that was actually collected, so it falls when denials rise and never exceeds the cash. Billed revenue is what the codes earn at the illustrative rates. Cash is what reaches the practice.
The nine codes in this build, with an illustrative rate for each
- 99453Setup and patient education$20.00
Kind: once. Billed under remote monitoring. Billed once for the patient, not every month.
- 99454Device supply, 16 or more days$45.00
Kind: monthly. Billed under remote monitoring. The device sends readings on at least 16 of 30 days.
- 99445Device supply, 2 to 15 days$15.00
Kind: alternative. Billed under remote monitoring. Readings on 2 to 15 of 30 days. Only one of the two device codes bills in a 30-day period.
- 99457Treatment management, first 20 minutes$50.00
Kind: time based. Billed under remote monitoring. At least 20 minutes of staff time and one live two-way contact with the patient or caregiver. No days-of-data test.
- 99470Treatment management, first 10 minutes$25.00
Kind: alternative. Billed under remote monitoring. New for 2026. At least 10 minutes and one live two-way contact. Only one of 99457 and 99470 bills in a month.
- 99458Treatment management, each added 20 minutes$40.00
Kind: time based. Billed under remote monitoring. Each full 20 minutes after the first 20 minutes billed as 99457.
- 99490Chronic care, first 20 minutes$60.00
Kind: time based. Billed under chronic care. The first 20 minutes of clinical staff time in a month.
- 99439Chronic care, each added 20 minutes$45.00
Kind: time based. Billed under chronic care. Each full 20 minutes after the first 20 minutes billed as 99490.
- 99484Behavioral health care management$50.00
Kind: time based. Billed under chronic care. 20 minutes of care management in a month.
Once means billed one time for the patient. Monthly and time based codes bill each month the test is met. An alternative is a lower version of another code, and only one of the two bills in the period. These are rounded, illustrative rates and not the fee schedule. A real payer pays its own amount for each code.
Checks that tie the numbers, 6 of 6 pass
- PassCode lines add up to the totals. Every program and the blend equal the sum of their code lines.
- PassExclusive pairs never bill together. No program bills both codes of a pair, and added blocks follow their first block.
- PassMix shares add to 100 percent. The three program shares add to exactly 100 percent.
- PassFee never exceeds collected cash. In every program the fee and the practice share add back to collected cash.
- PassEach minute counts once. Billed minutes never exceed the minutes that exist, even when both programs apply.
- PassCash never exceeds what was allowed. Denials only remove money, and payers plus patients equal collected cash.
Across this program mix a patient bills $108.58 a month at the illustrative rates, and $96.72 is collected after payer mix, denials and patient balances. The company earns $11.61 and the practice keeps $85.11. The largest code is 99457, at 30% of collected cash.