Your care management program, run by nurses.
Medicare pays your practice every month to manage chronic patients between visits. TULQ supplies the licensed nurses who do the work. You keep the billing, the chart, and the patient relationship.
CCM · APCM · PCM · TCMFlat fee per enrolled patientNo software to buy
The program is not complicated. Staffing it is.
Every practice we talk to already does this work. You call the patient who just got out of the hospital. You sort out the medication the cardiologist changed. You chase the mammogram. You do it for free, between patients, at six in the evening.
Medicare will pay you for that work every single month. What it wants in return is proof: documented consent, a care plan in the chart, tracked clinical time, and someone reachable around the clock. That is the wall practices hit, and it is a labour wall rather than a software wall.
At two hundred enrolled patients, twenty minutes each comes to roughly 67 hours a month of licensed clinical time. That is most of a full-time employee you do not have.
What the benefit actually pays.
2026 national averages under the Medicare Physician Fee Schedule. Your locality will differ, and these update every January.
A software wall and a labour wall are not the same wall.
Eligibility flags, consent capture, care plan templates, batch claim generation, dashboards. Real value, and it removes clicks.
Then someone on your team still has to pick up the phone twenty times a day, do the clinical work, and be reachable at 2 a.m. The software does not do that. Your medical assistant does, on top of everything else, until the program quietly dies.
Licensed registered nurses who make the calls, do the clinical work, document it in your chart, log the time, and answer the phone at night.
We work inside your system under your supervising provider. Your patients experience your practice, not a vendor. You bill it. We invoice a flat fee per enrolled patient per month.
Thirteen requirements. We own nine.
The ones marked for your practice are the ones only a billing provider can hold. Everything else is ours.
- 01A certified electronic health record. You almost certainly already have one.Your practice
- 0224 hour access to a care team member for urgent needs.TULQ
- 03A designated care team so patients get continuity rather than a stranger each month.TULQ
- 04A way to track time per patient per calendar month.TULQ
- 05Two or more chronic conditions expected to last twelve months or until death, placing the patient at significant risk.Your practice
- 06A qualifying visit first if the patient is new or unseen in twelve months. A wellness visit satisfies this.Your practice
- 07Documented consent covering cost sharing, one practice per month, and the right to stop at any time.TULQ
- 08A written care plan in the record, shared with the patient.TULQ
Insufficient time documentation is the most common denial in this benefit. Five of the thirteen requirements recur every single month, and all five are ours.
- 09At least twenty minutes of clinical staff time, for the time-based codes.TULQ
- 10Time logged with date, patient, staff member, and what was done. No carryover between months.TULQ
- 11The actual clinical work. Check-ins, medication reconciliation, gap closure, specialist and discharge coordination.TULQ
- 12The care plan kept current as things change.TULQ
- 13One practice billing that patient that month. We verify before enrolling.TULQ
Most vendors hide this list. We lead with it, because its length is the reason you are not billing this today. If a program is run casually by front desk staff between patients, it will fail an audit. That is the risk we are hired to remove, and it is why we log every minute in your chart rather than in ours.
Two instruments for the same clinical work.
| Chronic Care Management | Advanced Primary Care Management | |
|---|---|---|
| How it pays | About $66 for the first twenty minutes, stacking upward with additional tracked time. | A flat monthly amount by patient complexity: about $16, $54, or $117. |
| Time tracking | Required every calendar month. The main denial risk in the benefit. | None. No time threshold at all. |
| Quality reporting | None attached to the code itself. | Required. Straightforward if you already report, a real cost if you do not. |
| Best fit | Independent practices that want no new reporting obligations. | Practices already in an accountable care or shared savings arrangement. |
You cannot bill both for the same patient in the same month. We help you choose patient by patient, and we are indifferent to which you pick because our fee is identical either way.
Inside your practice, under your supervision.
You stay the doctor.
Care management runs under general supervision, so you direct care without having to be available while we work. You review and sign the care plan. Anything clinical routes back to you the same day.
We work in your chart.
Delegated access under a signed business associate agreement. Nothing lives on our side. Your billing team sees a complete, dated, defensible note every month.
Your patients hear your practice.
We introduce ourselves as your care team, because under the rules that is exactly what we are. No call center script, no vendor branding, no offshore handoff.
Flat fee, never a percentage.
Never a share of your collections, and our nurses are never paid per enrollment. Tying a vendor's pay to your Medicare reimbursement is the arrangement auditors look at hardest.
The G0511 sunset changed how health centers bill this.
G0511, the bundled general care management code that rural health clinics and federally qualified health centers reported for years, sunset on 30 September 2025. From 2026 those organizations bill the individual care management codes at national non-facility fee schedule rates, tracking time and documentation separately the way a fee-for-service practice does.
For a health center that had one bundled line and now has several coded ones, that is a genuine operational change rather than a paperwork tweak, and it arrived alongside the APCM codes. It is the single most common reason a health center calls us.
We have written the whole thing up. The transition itself, the replacement codes, the coinsurance, and the supervision rule that makes remote nursing possible: G0511 is gone, what health centers bill now. The APCM code detail on its own: APCM billing at an FQHC or RHC.
The questions you are going to ask.
What is the difference between CCM and APCM?
Chronic Care Management pays for time. You bill 99490 after at least twenty minutes of clinical staff time in a calendar month, and the time has to be logged with a date, a staff member, and what was done. Advanced Primary Care Management pays a flat monthly amount by patient complexity with no time threshold at all, which removes the single most common denial risk in the benefit.
The trade is quality reporting. APCM requires you to report the Value in Primary Care MIPS Value Pathway or participate in an ACO or primary care model. If you already report, APCM is usually the better instrument. If you do not, that obligation is a real cost and CCM may be the cleaner choice.
Source: CMS Advanced Primary Care Management servicesCan you bill CCM and TCM in the same month?
Not for the same patient in the same service period. Only one practitioner may bill care management for a given patient in a given calendar month, the same minute cannot be counted twice, and CCM and TCM cannot overlap inside the 30 day post-discharge window. APCM likewise cannot be billed with CCM, PCM, or TCM for the same patient in the same month.
We verify all of this before enrolling a patient, every month, and flag a conflict to you rather than submitting and hoping.
Source: CMS Chronic Care Management Services bookletWhat is the 2026 reimbursement for 99490 and the APCM codes?
As 2026 national averages: 99490 pays about $66 for the first twenty minutes of staff-directed CCM, with 99439 adding roughly $50 per additional twenty minutes up to two units. The three APCM codes pay about $16 (G0556, one chronic condition), $54 (G0557, two or more), and $117 (G0558, two or more plus Qualified Medicare Beneficiary status) per patient per month.
All of those are national averages adjusted by locality and updated each January. Run your own carrier before modelling on them.
Source: CMS Physician Fee Schedule lookupHow do RHCs and FQHCs bill care management in 2026 now that G0511 is gone?
G0511, the bundled general care management code, sunset on 30 September 2025. Beginning in 2026 RHCs and FQHCs bill the individual care management CPT and HCPCS codes at national non-facility fee schedule rates, which means tracking time and documentation separately the way a fee-for-service practice does rather than reporting one bundled line.
That is a real operational change and it is the single most common reason a health center calls us. We have written it up in full: G0511 is gone, what health centers bill now.
Source: CMS Information for Rural Health Clinics, January 2026Do we need to buy software?
No. We are not a software company and we do not resell one. Software vendors sell eligibility flags, consent capture, care plan templates, and batch claim generation, all of which remove clicks and none of which make the twenty phone calls. What stops practices billing this benefit is a labour wall, not a software wall.
If you already own a care management platform, our nurses will work inside it.
Who owns the patient relationship?
You do, and the rules require it. Care management runs under general supervision, so you direct the care without needing to be present while we work. Our nurses introduce themselves as your care team, because under the benefit that is exactly what they are. There is no vendor branding, no separate phone number, and no offshore handoff. You review and sign the care plan, and anything clinical routes back to you the same day.
Do my patients get a bill?
Under CCM, yes: roughly $13 a month in coinsurance at the standard twenty minute code. Most patients have secondary coverage or Medigap that absorbs it, and patients with Qualified Medicare Beneficiary status owe nothing. We screen for QMB status before enrolling and we say the cost out loud during the consent call, rather than letting a patient discover it on a statement and disenrol in anger.
Will this survive an audit?
That is the actual product. Insufficient time documentation is the most common denial in this benefit, and a program run casually by front desk staff between patients will not withstand review. Documented consent, a care plan in your certified record, time logged with date and staff member and activity, monthly eligibility verification, and no carryover minutes between months. We would rather bill you for fewer patients than hand you a claim you cannot defend.
Where to go next.
- CMS Advanced Primary Care Management services
- CMS Advanced Primary Care Management services FAQ
- CMS Chronic Care Management Services booklet, MLN909188
- CMS Care Management, Physician Fee Schedule
- CMS Information for Rural Health Clinics, MLN006398, January 2026
- CMS Physician Fee Schedule lookup
Payment amounts on this page are 2026 national averages under the Medicare Physician Fee Schedule. They are adjusted by locality and updated each January, so check the CMS fee schedule lookup for your own carrier before modelling on them. Nothing here is billing, coding, or legal advice for your practice. Reviewed August 2026.
Fifteen minutes, your real panel, honest numbers.
Bring your Medicare patient count. We will tell you what the program is worth at your locality, what it will cost you, and whether it is worth doing at all. Sometimes the answer is no.
Requirement matrix, supervision model, and sample monthly documentation.
Ask and we will send it the same day, with the reimbursement figures run against your own locality rather than a national average.