2026 CMS Update

One Program. Two Revenue Streams. Zero New Hires.

CMS now lets you bill Behavioral Health Integration alongside Advanced Primary Care Management — without tracking a single extra minute. RPM Logix already runs the infrastructure both programs require.

Potential combined revenue
$170–$260+
Per patient, per month for a typical APCM panel adding BHI. Layer in RPM where appropriate and some panels may exceed $260 per patient per month.
A typical 500-patient APCM panel adding the BHI add-on can generate $170–$260+ per patient, per month — combined with RPM, some panels exceed $260/patient/month.
The 2026 Opportunity

CMS Just Removed the Biggest Barrier to Behavioral Health Integration

Until the CY2026 Physician Fee Schedule, most practices skipped BHI — the reimbursement was lower than CCM, and the time-tracking burden didn't justify a separate workflow. That changed.

CMS finalized new behavioral health add-on coding that lets you bill eligible BHI services in the same month as APCM, with no additional time documentation. If you're already running APCM — or thinking about it — this is the highest-leverage addition available in 2026.

7–21%
CMS reimbursement increase across RPM, CCM, APCM, and BHI for 2026.
$
$16–$117/mo
APCM base reimbursement per patient, by complexity tier (G0556/G0557/G0558).
+
BHI Add-On
Behavioral health integration can be layered on top of APCM for eligible patients.
What's Included

Everything Required to Bill Compliantly — Already Built

APCM requires 13 service elements to be available to every enrolled patient. Most practices don't have the population health and care-gap reporting infrastructure to prove it. RPM Logix does — it's the same system already supporting your RPM and CCM programs.

Access & Continuity

  • 24/7 access to a care team member
  • Continuity with a designated practitioner
  • Alternative access (phone, portal, secure messaging)

Care Planning

  • Patient-centered, comprehensive care plan
  • Care transitions coordination
  • Medication reconciliation and management

Population Health

  • Population data analysis
  • Risk stratification
  • Performance measurement / MIPS Value Pathway reporting

Patient Engagement

  • Documented consent
  • Health risk assessment (annual)
  • Community resource identification
  • Ongoing patient/caregiver communication and education
BHI
Adding BHI

Our credentialed Care Team provides documentable BHI program engagement. No new hires.

Revenue Calculator

Estimate Your Program's Revenue

Enter your Medicare panel size and complexity mix to see a monthly and annual estimate for APCM + BHI, with the option to layer in RPM.

2026 Revenue Estimate

APCM + BHI Revenue Calculator

Estimate monthly and annual revenue for an APCM program with behavioral health integration layered on top — using 2026 CMS national average reimbursement rates.

Total panel size, not full practice roster — only patients enrolled in the program.
Level 1
G0556
20%
Level 2
G0557
55%
Level 3
G0558 (QMB)
25%
Share of the APCM panel that also qualifies for a behavioral health add-on code.
Estimated monthly revenue
$0
$0 average per enrolled patient
Estimated annual revenue $0
APCM L1 APCM L2 APCM L3 BHI
Schedule an APCM + BHI Review
Estimates use 2026 CMS national average reimbursement rates and are for illustrative purposes only. Actual reimbursement varies by locality, patient complexity, and payer. Not billing, legal, or financial advice.
Estimates use CMS national average reimbursement rates for 2026 and are for illustrative purposes only. Actual reimbursement varies by locality, patient mix, and payer. This is not billing, legal, or financial advice — consult your compliance and reimbursement advisors before submitting claims.
Why RPM Logix

We Already Run This Infrastructure — For RPM and CCM

01

No new staff.

Our credentialed Care Team provides documentable BHI program engagement. No new hires.

02

No new platform.

Population Health Module and Care Gap reporting are already live. APCM's hardest requirement to prove is one you're already meeting.

03

No new billing complexity.

We handle enrollment, consent documentation, monthly attestation, and claims-ready reporting — the same workflow as your existing RPM/CCM program, extended to cover APCM and BHI.

FAQ

APCM + BHI Frequently Asked Questions

Can I bill APCM and CCM for the same patient?
No — CMS treats these as mutually exclusive per patient, per month. Most practices route higher-complexity, lower-adherence patients to APCM and keep time-intensive CCM patients where it makes sense. We help you segment your panel correctly.
Can I bill APCM alongside RPM?
Yes. APCM and RPM are not mutually exclusive and are commonly billed together for the same patient.
Do I need a new EHR integration?
No — if you're already on RPM Logix, your existing EHR integration (including eClinicalWorks) already supports APCM and BHI documentation and claims workflows.
How fast can we add BHI to an existing APCM program?
Typically within one billing cycle, since consent, care planning, and population health infrastructure are already in place.

Add Behavioral Health to Your Program This Month

If you're already running APCM with RPM Logix, BHI is an extension of infrastructure you already have. If you're not yet running APCM, we'll show you exactly where it fits alongside your current RPM/CCM program.