RPM/RTM Revenue Calculator

Customer Persona: Telemark Health Segment B Device-Enabled RPM Operator ▼

Tracks
RPM-HTN + RPM-HF

Stage
18 months in (May 2026)

Enrolled
~2,400 patients

Ops Model
Clinician-led + cellular devices

Storyline
"The Engagement Cliff"

Company Profile

Company

Telemark Health

Series A virtual hypertension & heart failure RPM startup. ~$28M raised across seed + Series A. Composite archetype modeled on the early-stage profile of companies like Cadence (pre-Series B), Story Health, and Heartbeat Health.

What They Do

Direct-to-patient virtual care for Medicare beneficiaries with hypertension and heart failure. Ship cellular-enabled BP cuffs and weight scales to enrolled patients, then provide ongoing monitoring + medication titration through their own NP and clinical pharmacist team. Bills RPM codes (99453/99454/99457/99458) under their own organizational NPI. The model that real RPM operators converge on — see Cadence's published outcomes for the mature version of this archetype.

Clinical Workforce	~18 NPs (W-2, full-time), ~6 clinical pharmacists, ~12 MAs for device logistics. Cardiologist medical director (part-time).
Primary Markets	FL, TX, AZ initially; expanding to NC, GA. Targeting Medicare FFS in retirement-dense MSAs.
Medicare Status	Organizational NPI active. Billing live since month 4. ~14 months of claims history.
Devices	Cellular BP cuffs (no smartphone required) + cellular weight scales for HF patients. ~$120 unit cost, 18-month device life.
RPM Revenue	~$2.3M ARR run-rate based on current panel + engagement. RPM-only (RTM would require a disjoint patient cohort due to dual-billing rules).

1Phi Segmentation

Segment	B Device-Enabled RPM Operator
Mindset	Unit-economics operator
Ops Model	Clinician-led + device-enabled
GTM Orientation	Provider-referral + direct Medicare
Price Model	Fee-for-service Medicare billing
Friction Point	Every billable patient-month requires both device compliance (≥2 days) and clinician time (≥10 min) — engagement gaps drop revenue to $0 fast

Capability vs. Track Requirements

Track	Condition	Telemark Capability	Notes
RPM	Hypertension	Strong — cellular BP cuff + NP titration	Core program (~80% of panel)
RPM	Heart Failure	Strong — daily weight + symptom checks	~15% of panel; higher-touch
RPM	Diabetes	Moderate — no CGM yet, scale only	Roadmap, not in baseline

Our Story

Setting the Scene

Telemark launched their hypertension program in late 2024 and started billing Medicare in month 4. Eighteen months in (May 2026), they've enrolled ~2,400 patients across FL, TX, and AZ. The board sees a clean revenue ramp on the gross panel-size chart — but the CFO knows the per-patient math is messier than the deck suggests.

Roughly 60% of patient-months hit the 16-day device threshold needed for the full 99454 rate. About 70% of those device-compliant patients get the live 20-minute interaction required for 99457. The rest fall into the new 2026 lower-tier codes (99445/99470) — or generate no bill at all that month.

The Engagement Cliff

RPM revenue is binary at the patient-month level. Hit 16 device-days and bill $52; miss it by one day and either drop to $47 (new 99445) or zero (no bill). Hit 20 minutes with a live conversation and bill $52; fall short and either drop to $26 (new 99470) or zero. Every patient sits on a cliff, every month. The new 2026 codes soften the cliff but don't eliminate it — and most operators have no real-time view of where each patient sits.

RPM/RTM Revenue Calculator RPM-HTN + RPM-HF — Telemark Health — 18 months

Figures use synthetic sample data for illustration.

Enrolled Patients iTotal patients currently enrolled across RPM tracks. ~85% HTN, ~15% HF.

2,400

+8% MoM

Monthly Revenue (Run-Rate) iSum of allowed amounts billed this month across all enrolled patients. Driven by panel size × the patient-month code mix. No withhold — RPM/RTM is pure fee-for-service.

$193K

$80.50 / patient / month avg

Device Compliance i% of patient-months hitting 16+ days of device data transmission. Drives 99454 billing ($52). Below 16 days but ≥2 days drops to new 2026 code 99445 ($47). Below 2 days — no device-side billing. Industry benchmark: Cadence reports 84%.

62%

Industry best-in-class: 84%

Management Completion i% of patient-months where clinical staff hit 20+ min of time AND ≥1 live interactive communication. Drives 99457 ($52). Between 10-19 min drops to new 2026 code 99470 ($26). Under 10 min — no management billing.

71%

Of device-compliant patients

Avg Add-On Units iAverage 99458 add-on units per managed patient-month. Each add-on = +20 minutes beyond the first 20. Max 2 per month by CMS rule. HF patients average higher (~0.7) than HTN (~0.2). Each unit bills $41.

0.31

Avg per managed patient-month

Active Devices iNumber of cellular BP cuffs + weight scales currently deployed in the field. Should track close to enrolled count minus churned-but-not-returned devices.

2,340

98% device deployment

New Setups (99453) / Month iPatients onboarded this month who triggered the one-time 99453 setup fee ($22). Drives the small "step up" in monthly revenue when growth is strong.

186

$4,092 setup revenue this month

Zero-Bill Patients iPatients enrolled but generating no billable code this month — missed both device and management thresholds. Pure cost (device amortization + overhead) with no offsetting revenue. Re-engagement target.

347

14% of panel

Avg Sessions / Mo iAverage number of clinical encounters (phone, video, or messaging with live response) per enrolled patient per month. Drives 99457/99470 eligibility. Target ≥1.0 to ensure interactive communication requirement is met.

1.1

Target: ≥1.0 for billable mgmt

Monthly Churn i% of enrolled patients leaving the program this month (disenrollment, death, transferred care). Industry typical for RPM is 2-4% monthly. Lowers net growth rate.

3.2%

~75 patients/mo

Monthly Revenue Composition — by Patient Story Fee-for-service, stacked by code combination per patient-month Preset

Model my practice

Three questions. We'll project a smooth 24-month ramp from launch using a documented S-curve for enrollment and engagement maturity. Coupled so you can't accidentally build an implausible mix.

Panel at Month 12 target enrolled

1,200

How many patients do you expect to have enrolled by the end of year 1?

Ramp Speed months to maturity

How quickly do staff & patients hit steady-state engagement?

Steady-State Quality end of ramp

Where do device-compliance / mgmt-completion settle after ramp?

Modeling assumptions: enrollment follows a logistic S-curve to your month-12 target then continues at ~3%/mo; device-compliance and mgmt-completion ramp from 25%/30% (launch) to the steady-state values you select, on the ramp-speed schedule; add-on intensity (99458) ramps from 0.05 to a level matched to your quality choice. All engagement microstructure constants held at field-tested defaults (65/70/50) — switch to Case Study mode to tune them.

Net Panel Growth Actual: ~8%/mo

+8%

New enrollments minus churn

Device Compliance % ≥16 days

62%

Remainder splits via Engagement Microstructure below

Mgmt Completion % ≥20 min + live

71%

Of device-compliant patients

Avg Add-On (99458) Per mgd pt-month

0.31

Max 2.0 per CMS rule

Engagement Microstructure Advanced — how engagement misses distribute across new partial-credit codes ▼

Engaged bundle (99454+99457+99458) Standard bundle (99454+99457) Device only (99454 or 99445) Low-touch (99445+99470, new 2026) Onboarding (99453)

Export Export to Google Sheets

Generates a Google Sheet with full data and calculations:
• Data tabs — patient roster, device-day logs, time logs
• Calculator tabs — formulas driving the patient-story decomposition
• Scenarios tab — editable what-if workspace

All formulas are transparent and editable. Snapshot at export time.

Patient-Story Decomposition

Every chart bar above is built from these ten patient-month archetypes. Every enrolled patient generates exactly one story per month — the calculator counts how many patients land in each bucket given the slider settings, then multiplies by the 2026 PFS rate for that bundle. CMS pays per code, not per patient-month, but operators think in stories. The "engaged" and "off" cards are the two ends of the value distribution; the middle cards are what most patient-months actually look like.

1 · Onboarding only

99453

$22

First month after enrollment, one-time

2 · Onboarding + first month

99453 + 99454 + 99457

$126

Strong launch: device hits 16+ days, mgmt hits 20 min

3 · Onboarding + first month engaged

99453 + 99454 + 99457 + 99458

$167

High-touch launch with 40+ min mgmt

4 · Steady-state device only

99454

$52

Device compliant but no live conversation that month

5 · Steady-state standard

99454 + 99457

$104

The modal steady-state month for engaged patients

6 · Steady-state engaged

99454 + 99457 + 99458

$145

High-acuity HF or labile-HTN patient with 40 min mgmt

7 · Steady-state max

99454 + 99457 + 99458 × 2

$186

60+ min mgmt — rare, post-discharge or complex titration

8 · Off month

— no bill —

Device < 2 days AND mgmt < 10 min — common in disengaged tail

9 · NEW 2026 · Low-touch

99445 + 99470

$73

Device 2-15 days + mgmt 10-19 min · partial-credit floor

10 · NEW 2026 · Partial-mgmt

99454 + 99470

$78

Device compliant + brief check-in · saves the bar

Why the 2026 codes matter: 99445 and 99470 are new partial-credit codes finalized in the CY 2026 Medicare PFS Final Rule. Before 2026 a patient with 10 device-days and 12 mgmt-minutes was a $0 month. In 2026 that same patient is a $73 month (story 9). For the current panel where ~34% of patient-months fall in these new-code windows (computed live from sliders), the 2026 codes are worth roughly ~$697K/year of revenue that was previously left on the table (nSight Care 2026 RPM guide; figure recomputes when you move the sliders above). Code mutual-exclusivity: 99454 ⊕ 99445 (device tier) and 99457 ⊕ 99470 (mgmt tier) — pick one of each pair per patient per month.

Monthly Revenue Detail — 18 Actuals + 12 Projected ▼

How RPM/RTM Billing Works The 2026 codes and the levers that move revenue ▼

Payment Timing — Pure FFS, Monthly Claim, No Withhold

RPM/RTM payments are per-claim, per-patient, per-month. There is no withhold and no quarterly reconciliation. Each CPT code is billed independently for the patient-month and paid at the 2026 PFS national average within ~14–30 days under standard MAC claims processing.

Unlike ACCESS or other value-based programs, there are no quarterly spikes or dips — the chart above is smooth because cash flow is smooth. Volatility comes entirely from the composition of patient-months: how many patients hit which engagement thresholds.

Per-Code Rates — 2026 PFS National Average

Rates below are CY 2026 Medicare PFS national average non-facility, $33.40 base conversion factor (or $33.57 for qualifying APM participants). Geographic locality adjustments (GPCI) move rates ±5-15% by region; commercial payers vary widely (~70-130% of Medicare).

CPT	Description	Period	2026 Rate	Threshold
99453	RPM device setup & patient education	One-time per episode	$22	Consented + device shipped
99454	RPM device supply, daily transmissions	30-day period	$52	≥16 device-days
99445 NEW 2026	RPM device supply, partial	30-day period	$47	2–15 device-days
99457	RPM treatment mgmt, first 20 min	Calendar month	$52	≥20 min + live comm
99458	RPM treatment mgmt, add-on 20 min	Calendar month	$41	Each additional 20 min
99470 NEW 2026	RPM treatment mgmt, brief	Calendar month	$26	10–19 min
RTM (MSK pilot — 5% of panel)
98975	RTM device setup	One-time per episode	$20	Consented + device delivered
98977	RTM device supply, MSK	30-day period	$40	≥16 device-days
98980	RTM mgmt, first 20 min	Calendar month	$54	≥20 min + live comm
98981	RTM mgmt, add-on 20 min	Calendar month	$41	Each additional 20 min

Sources: nSight Care 2026 RPM CPT guide · Tenovi 2026 RTM codes · CMS CY 2026 PFS Final Rule.

Add-On Logic (99458)

99458 is uniquely valuable because it stacks. A patient who gets 60 minutes of management generates 99457 + 2× 99458 = $52 + $82 = $134 just for mgmt. Most operators leave 99458 on the table — the add-on slider models how aggressively the clinical team documents and bills additional 20-min blocks.

For Telemark's current panel, moving the add-on slider from 0.31 to 0.75 — a documented best-practice intervention — is worth an additional ~$19K/month at steady state without enrolling a single new patient (computed live from the current device + mgmt sliders, which determine how many patients are in the engaged bucket where the add-on applies). This is the engagement-cliff lever.

New 2026 Codes — Mutual Exclusivity

CMS designed the new partial-credit codes (99445, 99470) as mutually exclusive with their full-credit siblings. A single patient-month can bill either 99454 or 99445 — never both. Same for 99457 vs 99470. This is the partial-credit cliff the CY 2026 rule is designed to soften.

The clinical implication: documentation discipline matters more than ever. A 12-minute call that previously yielded $0 now yields $26. A 19-minute call yields $26 — but a 20-minute call yields $52 plus an add-on opportunity. The 20-minute threshold remains the high-leverage operational target.

RTM Stacking — Out of Scope

RPM and RTM cannot be billed concurrently for the same patient in the same calendar month for the same condition (CMS dual-billing rule). RTM revenue therefore does not stack onto an RPM panel — it would require a separate, disjoint patient cohort with a different qualifying condition (typically MSK or respiratory).

Modeling that disjoint cohort cleanly requires its own enrollment, eligibility, device-day, and time-log streams, which is outside the scope of this calculator. RTM rates are kept in the CALC-02 reference table for completeness, but no RTM revenue is included in the chart, the headline metrics, or the projection.

If you need RTM revenue modeling, build it as a parallel calculator with its own panel, not an addition to this one.