Get paid between visits
Chronic care management for rheumatology practices
Companian handles lab reminders, infusion confirmations and flare check-ins, so your nurses don’t have to.
- No new hires. We run outreach, consent and monthly calls.
- One file a month. Nothing is billed until you approve it.
- $0 upfront. Works with your EHR, live in about a week.
$66.13* per patient, every month*Rheumatology CCM, CPT 99490 (2026 national rate)
Get your CCM Plan
Works nationwide
Practices nationwide
You bill under your own NPI
Same Care Advocate every month
RNs, NPs, LCSWs and care companions
Monthly file approved by your team
No new hires needed
One Care AdvocateSame person, every month
Your NPI, your claimYou bill Medicare directly
Monthly billing fileYour team approves it
Rheumatic conditions and the program that fits
Count the conditions you manage: one points to PCM, two or more to CCM.
| Condition | What the monthly calls cover | Program to consider |
|---|---|---|
| Rheumatoid arthritis | Methotrexate or other monitoring bloodwork reminded and confirmed; flare questions from your plan | PCM when RA is the one condition you manage |
| Psoriatic arthritis | Biologic infusion or injection-visit dates confirmed; joint and skin questions your plan sets | PCM for the one condition you follow |
| Systemic lupus erythematosus and vasculitis | Lab and visit schedules confirmed; new-symptom questions recorded | PCM, or PIN (G0023, G0024) if the presentation is serious and high-risk |
| Gout | Uric acid lab dates confirmed; flare reports recorded | PCM if your practitioner finds it meets the high-risk definition |
| RA plus osteoporosis, both managed by your practice | Questions for each condition in one monthly call | CCM: two or more chronic conditions expected to last 12 months |
PCM requires one serious, high-risk condition expected to last at least 3 months. PCM CPT codes explained.
What 120 RA, lupus and psoriatic arthritis patients bring in each month
2026 Medicare-allowed amounts, and the diagnosis codes that qualify.
Example panel
$7,936 / month
$95,227 a year · 120 patients × $66.13 (CPT 99490, national)
- CPT 99490 pays $66.13 per patient-month nationally (2026).
- Your locality moves it up or down: $60.71 in Arkansas to $83.76 in Alaska.
- Each extra 20 minutes adds CPT 99439 at $50.44.
| Condition | ICD-10 examples | Program fit |
|---|---|---|
| Rheumatoid arthritis | M06.9 | CCM with a second condition; PCM alone |
| Systemic lupus erythematosus | M32.9 | CCM with a second condition |
| Psoriatic arthritis | L40.50 | CCM with a second condition |
| Gout | M10.9 | CCM with a second condition |
A month built around monitoring labs
Your staff shares the list, approves outreach and signs off the file.
Outreach and consent
After the initiating visit, the Care Advocate calls, explains the program and cost-sharing, and documents verbal consent.
The lab calendar
Your plan sets when monitoring bloodwork is due. The Care Advocate reminds the patient beforehand and confirms the draw afterwards.
Infusion chair dates
Biologic infusion appointments your office books are confirmed before chair time. No-shows go to your staff to reschedule.
Flare questions and the file
Calls ask your plan’s flare questions, like new swelling or longer morning stiffness. Gloria, an AI assistant, drafts the notes.
Chronic care management for rheumatology practices: 2026 codes
2026 national payment for each code.
| Code | Service | National 2026 |
|---|---|---|
| 99426 | PCM, clinical staff, first 30 min | $67.80 |
| 99427 | PCM, clinical staff, each additional 30 min | $54.11 |
| 99424 | PCM, rheumatologist personally, first 30 min | $87.51 |
| 99425 | PCM, rheumatologist personally, each additional 30 min | $61.46 |
| 99490 | CCM, clinical staff, first 20 min | $66.13 |
| 99439 | CCM, each additional 20 min | $50.44 |
Staff time or rheumatologist time
Clinical staff time and your rheumatologist’s own time bill under different PCM codes. Medicare pays no PCM for a month under 30 minutes.
CCM time thresholds
CCM starts at 20 minutes of clinical staff time in a calendar month; complex CCM (99487) starts at 60. Only one practitioner may bill CCM for a patient each month, so check with primary care first. The basics behind these rules are in our explainer, what is chronic care management.
Claims and localities
Claims go to your Medicare Administrative Contractor, and payment varies by locality: 109 nationwide. CCM reimbursement by locality.
Care Advocates track. Rheumatologists decide.
No dose changes, no reading of results, no medical advice from Care Advocates.
| Situation | Care Advocate | Your clinicians |
|---|---|---|
| Monitoring bloodwork due | Reminds the patient and confirms the draw took place | Order, read and act on the result |
| New joint swelling or stiffness | Records it and routes it under your escalation rules | Decide whether treatment changes |
| Side-effect question about a biologic | Writes the question down and sends it to your nurse | Answer it and decide next steps |
| Physical therapy your clinicians ordered | Confirms the patient attended the booked visits | Review progress and adjust the plan |
Calls come from registered nurses, nurse practitioners, licensed clinical social workers and care companions, by phone or video. CMS lets clinical staff furnish CCM incident to the billing practitioner under general supervision. Your services agreement sets the terms; have counsel confirm them.
Questions rheumatology practices ask
Can CCM run alongside remote monitoring?
Yes, with one limit: CMS allows CCM with either remote physiologic monitoring or remote therapeutic monitoring in the same period, not both. CCM vs RPM.
Can you handle biologic prior authorizations?
No. Prior-authorization requests and payer follow-up stay with your staff. The Care Advocate passes along what the patient reported.
Do established patients need a new visit before CCM?
Only if they are new to your practice or have not been seen within the past year. Then CMS requires a comprehensive face-to-face E/M visit, an annual wellness visit or an IPPE first.
What do patients agree to at consent?
CMS lists four points: the service exists, Part B cost-sharing applies, one practitioner bills CCM each month, and the patient can stop anytime. The Care Advocate covers all four and records verbal consent. CCM consent rules.
Who receives the Medicare payment?
Your practice, under its own NPI. Companian does not bill Medicare; we cover our fee on the intro call. Cost details.
Rates & disclosures
National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.
Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.
Care management for other specialties
Care Advocates follow the same model across specialties.
Add care management to your rheumatology practice
A 15-minute call on which program fits. No patient data needed.