San Diego Cardiac Center has been billing remote physiologic monitoring since before most cardiology groups in the country — seven of nineteen physicians, roughly 241 Medicare patients, $199,018 allowed in CY2024. But the add-on rung is billed by exactly one physician, and transitional care, principal care management, 99091 and remote therapeutic monitoring return zero services across all twenty-three practitioners. This page shows what happens when the same clinical discipline is run as a service line — in the first year five hospitals the group staffs carry mandatory 30-day episode accountability.
Source: the companion CoachCare Value Analysis workbook, MAC locality CA • 01182-72.
Nothing on this page argues that this practice should start doing remote monitoring. Its own Medicare claims show it already does — on the physiologic side and, separately, on the device side. The argument is about the other two thirds of the bench, and about the rungs of the ladder above and below the ones being billed.
CPT 99453 · 99454 · 99457 · 99458 across seven of the group's nineteen CMS-listed physicians, on roughly 241 Medicare fee-for-service patients and 3,678 services. That is a working service with device logistics, data review and monthly management time behind it, not a pilot.
The 932xx family — remote pacemaker and defibrillator interrogation, rhythm monitoring and implantable hemodynamic monitoring — carried $99,770 across 2,721 services in the same year. The organizational muscle for remote data review is in the building already.
The heart failure programme runs with a dedicated heart-failure nurse practitioner; the anticoagulation clinic runs a 15-minute recurring-visit protocol with nurse verification of dosing. Nurse-led, protocol-driven, between-visit chronic care is not a concept this group needs sold to it.
Every practitioner reassigning to the group — all twenty-three — was queried individually against the full CY2024 Medicare care-management code set. Chronic care management, principal care management, transitional care management, remote physiologic data review and remote therapeutic monitoring returned zero services on every code. Verified absent, not suppressed.
Read as a share of the group's own book, the picture is sharper still: CY2024 traditional-Medicare allowed charges across twenty practitioners were $8,926,576, and the remote-monitoring line inside that is $199,018 — roughly 2.2% of the practice's own Medicare revenue. The programme is not failing. It is stranded — run as a clinical habit by a minority of the physicians rather than as an operationalised service line, and marketed nowhere: a crawl of all 95 pages on the practice's website returns zero mentions of remote monitoring, care management or any monitoring platform.
The right reading of that is a compliment, not a criticism. This group proved the clinical model before most cardiology practices in the country did, and then never built the machine around it. The clinical substrate underneath is unusually deep for a group this size — three of the nineteen CMS-listed physicians are board-certified in advanced heart failure and transplant cardiology, the practice was a site on a pivotal implantable pulmonary-artery-pressure trial, and it remains an active site on a remote-sensor insertable-cardiac-monitor study.
The Transforming Episode Accountability Model makes a hospital financially accountable for a 30-day post-discharge episode, readmissions included. This practice holds no CCN and is not a participant. Its admitting hospitals carry the risk. It supplies the cardiology — and it bills no transitional care at all.
CMS facility-affiliation data resolved across the group's eighteen cardiology NPIs places privileges at five hospitals that are all mandatory TEAM participants: Sharp Grossmont (CCN 050026), Sharp Chula Vista (050222), Sharp Memorial (050100), Sharp Coronado (050234) and Scripps Mercy San Diego (050077) — all in CBSA 41740, all with a performance period running 1 January 2026 to 31 December 2030.
Said plainly: the practice has no CMS Certification Number and is not itself a TEAM participant — participation attaches to a hospital CCN. All fifteen hospitals in the CBSA are mandatory participants, and following the July 2026 transfer of Tri-City Medical Center, Sharp now operates six acute-care hospitals in the county, five of them in TEAM. That makes this a system-level conversation, not a hospital-by-hospital one.
99495 and 99496 returned zero services across all twenty-three practitioners in CY2024. The transitional-care family is the direct billing instrument for the 30-day post-discharge window — the exact window five mandatory-TEAM hospitals are now reconciled on — and it is completely unbilled by the cardiology group that follows those patients out.
That is a rare alignment: a hospital-side financial mandate that began seven months ago, a specialist group that touches those discharges and holds the ambulatory relationship afterwards, and an empty post-discharge code set at that group. The practice is currently on the wrong side of it by default rather than by decision.
New codes 99445 (2–15 days of device data, where 16 or more were previously required) and 99470 (first 10 minutes of monthly management, where the floor had been 20) make short post-discharge and post-procedure windows cleanly billable for the first time. That is precisely the window TEAM reconciles on.
A named service line with its own owner, P&L and scorecard, following the Medicare patient from the hospital bed back into the practice and then across the year. Built once, reused for every lever the group already cares about.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use | In the model? |
|---|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200 / ~$280 | Every discharge from the five mandatory-TEAM hospitals the group staffs — at zero services today | No — upside |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 opens the 2–15-day post-discharge window; 99453 captured on 41 patients against 241 on device supply | Yes |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, titration, escalation. 99458 is billed by exactly one physician today — the clearest single capture gap in the file | Yes |
| Principal Care Management | 99424 · 99425 · 99426 · 99427 | ~$79 / ~$57 · ~$60 + ~$50 add'l | Single high-risk cardiac condition managed by a specialist; clinical-staff codes are the workhorse of a full-service care team | Yes |
Magnitudes in this table are national non-facility figures. The value analysis below uses CY2026 rates auto-resolved by MAC carrier and locality for zip 92123 — CA • 01182-72 — not these national figures.
The same infrastructure — enrolment, devices, alert triage, escalation, documentation, billing capture — powers each thing the group already cares about.
Most remote care proposals open with an integration promise. This one does not, because the integration seam here is not the practice's to sell into. Here is exactly what is verified about the platform, what follows from it, and what the service line runs on in the meantime.
The value analysis on this page does not assume any particular integration depth. No interface cost, timeline or capability is priced into the forecast, and none is claimed here.
The economics prove the service line pays. This proves it is safe and disciplined. Every reading a patient takes routes through one shared escalation engine with defined thresholds, defined trends, defined routing and a defined documentation standard — so the practice receives signal, not noise, and never carries surveillance liability it did not agree to.
Both programmes in this service line — remote physiologic monitoring and principal care management — route through the same logic. The engine is programme-agnostic; the thresholds are set with the practice.
A reading at a critical threshold escalates regardless of whether the patient reports symptoms. There is no "wait and see" branch on a critical value, and no client preference can suppress it.
A non-critical out-of-range reading is worked rather than forwarded: confirm technique, retake, then run a structured symptom check. Most out-of-range readings resolve here — which is exactly why the practice's inbox stays clean.
An out-of-range trend is not a judgement call. It is three consecutive readings at least one hour apart for blood pressure or glucose, or three readings within seven days for heart rate. A confirmed trend escalates on the same footing as a threshold breach.
If the patient cannot be reached, the attempt is documented, a voicemail and callback request are left — and if the reading was critical or a confirmed trend, the escalation proceeds anyway. Silence never downgrades a clinical finding.
Six fields, every time, so the record is auditable and the practice can reconstruct any event.
Triggered automatically by any emergency-room visit or hospitalisation reported in the last 60 days. This is the readmission-prevention spine — and the mechanism behind the 301 hospitalizations avoided in the forecast below. It matters here specifically: five hospitals the group staffs now carry 30-day post-discharge episode accountability, and the cadence lands entirely inside that window.
Confirm the patient is home and safe, reconcile discharge medications against what is actually in the house, verify follow-up appointments exist, and confirm the monitoring device is set up and transmitting. Clinical alerts documented and escalated per the engine above.
The window where post-discharge decompensation typically declares itself. Symptom review, weight and blood-pressure trend review against the readings already flowing in, adherence check, and escalation on any confirmed threshold or trend.
Confirm the follow-up visit happened, close open issues, verify the patient understands the escalation path, and hand the patient into the longitudinal monitoring panel so the 30-day window closes with continuity rather than a cliff.
Patients do not silently fall out of the programme, and the practice is notified at every decision point.
A patient who stops responding is escalated to the practice first, then re-escalated every 30 days — not quietly dropped and not left accruing.
If no instruction is received from the practice, discharge proceeds at 180 days. The practice is notified in every case, and discharges generally process in the first week of the following month.
Clinical discharge criteria, escalation thresholds and routing are the practice's to set. CoachCare executes them consistently and documents the execution — it does not overrule clinical judgement, with the single exception of the emergent floor above.
Because every escalation carries the same six documented fields, any episode can be reconstructed end-to-end — which is what a shared-accountability conversation with a hospital partner, or a CMS model reviewer, actually requires.
A 24-month forecast for a two-programme service line — remote physiologic monitoring and principal care management — across the group's offices, 26 referring providers, one CoachCare-funded on-site enrolment specialist, and CY2026 rates auto-resolved for MAC locality CA • 01182-72. It models $6,608,698 of net reimbursement and $2,811,277 net to the practice over 24 months — a 42.54% practice margin (net to the practice ÷ net reimbursement), 42.18% in Year 1 and 42.66% in Year 2. Transitional care management revenue, TEAM episode performance, avoided-admission savings, procedural throughput and all Medicare Advantage and commercial volume are not in these numbers. They are upside on top.
| Line | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $1,237,379 | $3,778,465 | $5,015,843 |
| PCM net reimbursement | $385,565 | $1,207,290 | $1,592,855 |
| Total net reimbursement | $1,622,944 | $4,985,754 | $6,608,698 |
| CoachCare fees | $938,377 | $2,859,045 | $3,797,421 |
| Practice net (after fees) | $684,567 | $2,126,710 | $2,811,277 |
| Practice margin | 42.18% | 42.66% | 42.54% |
| Practice margin is net to the practice ÷ net reimbursement. Includes one on-site enrolment specialist staffed at CoachCare's expense — embedded value already reflected in the fees above, never a deduction from practice margin. | |||
Month-1 practice profit is −$2,419; the first profitable month is month 2. Unit economics are modeled at approximately $111.25 of net reimbursement per RPM patient-month and $99.69 per PCM patient-month, across 45,086 RPM and 15,978 PCM patient-months. The full model is available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months — on top of the existing procedural, imaging and device book, not instead of it.
A continuous clinical picture of the heart failure, hypertension and post-procedure panels between visits — the physiologic twin of the device data the group already reviews.
Roughly $4.5M of avoided acute cost at $15,000 per admission — and direct 30-day episode relief for the five mandatory-TEAM hospitals the group staffs.
48,901 care-team hours of monitoring, outreach, escalation and documentation carried by the service line rather than by practice staff.
Every input below is an assumption, and every assumption is arguable. Move them and the 24-month forecast recomputes live. At the modeled settings this engine reproduces the companion Value Analysis workbook exactly — so any disagreement you have with the output is really a disagreement with an input, which is a much more productive conversation.
"Enrolled services" counts active programme enrolments; a patient enrolled in both programmes counts twice. At month 24 the model's 4,939 enrolled services correspond to 4,034 unique patients once dual enrolment is deduplicated.
CoachCare operates the engine — enrolment outreach, device logistics, 24/7 monitoring, escalation and billing-ready documentation — while the group's physicians govern the protocols and make every clinical decision. Full-service delivery means launch requires no new practice headcount, and the on-site enrolment specialist in the model is funded by CoachCare.
Name a physician lead and pair them with the administrative lead. Put the existing enrolled remote-monitoring patients under one protocol before adding a single new one. Confirm the billing configuration for MAC locality CA • 01182-72, agree the escalation matrix and discharge criteria, and settle the attribution rule in writing.
First, the heart failure panel — the highest-yield population and the one this group's bench is built for. Second, post-discharge patients from the five mandatory-TEAM hospitals, on the three-touch cadence with short-window RPM placed at discharge. Stand up the daily discharge signal alongside them; it is the item most worth the hospitals' cooperation.
Referral pathway made a single order rather than a personal workflow, across Kearny Mesa, Chula Vista, El Cajon and the hospital-campus sites. Longitudinal RPM and PCM panels running under protocol; the add-on rung and setup code captured by the billing engine rather than by hand. Monthly scorecard — census, capture rate, revenue per patient-month, escalation volume, readmission signal — reporting to practice governance.
A documented 30-day post-discharge track record to take into the hospital conversation — which is where the episode-risk discussion becomes a negotiation rather than a request — and a full year of capture data on a service line whose first-year census is still climbing.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for more than 500,000 patients.
Providers running remote care programmes day to day.
Successful programme implementations.
Care plan coding and billing generating over five million claims.
Over 100 million vitals recorded and more than four million care actions enabled.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how the operating model behind this service line absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That distinction lands directly on this forecast — PCM carries $1,592,855 of the modeled $6,608,698 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the service line's economics hold wherever the rule settles. One unbundles the program into its parts — SaaS platform, device logistics, and program enablement — priced as components. Another engages CoachCare to run the staffing itself, an MSO-style arrangement in which the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is among its four clinical tracks. What earns under that structure — controlled pressures, titrated therapy, decompensations caught early — is what this service line is built to produce.
This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality rather than national averages. Same enrollment, same phasing plan — only the rates move.
Both bars run on the same dollar scale, so the red slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the care-management revenue RPM alone does not include.
Repriced at this locality's own geographic adjusters. The RPM reductions fall almost entirely on practice expense, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be −8.8% on RPM. Of the $475,636, RPM accounts for $474,876 and the care-management arm for $760.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99424–99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those families moves within about 4% in either direction, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, and CMS publishes the affected codes, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.