A comprehensive review of added service options for primary care surfaces a few with eye-popping indications for new revenues, but closer inspection reveals those revenues are not likely to materialize. Specifically, carefully harmonized CMS data with common denominators indicates a clinic might expect both remote patient monitoring (RPM) and chronic care management (CCM, including advanced primary care management or APCM) to generate about $50,000 per 100 patients over three years, net of investment in software. Annual wellness visits might be expected to generate nearly half that amount, over $22,000. Real-world historical capture and delivery cost for these three services demonstrate that these amounts are not remotely realistic.
The three year revenue figures in Table 1 for these services all assume the practice closes the whole gap, meaning the clinic successfully enrolls every patient who qualifies for RPM, CCM/APCM, or AWV but doesn’t currently receive the service, then bills each such patient at the measured national frequency for three years. Here are the realities.
Remote patient monitoring
Very few eligible patients ever get remote monitoring. In Louisiana, 1.6% of Medicare patients with diabetes or high blood pressure used it between 2016 and 2020. That figure comes from a 2026 study in JMIR of 480,592 patients. Practices explicitly built around remote monitoring do far better than 1.6%, as one would hope and expect, but they still capture only about one in five eligible patients, 21.5%, according to a 2022 study in Health Affairs, and that’s the best published success rate we could find. Attrition degrades not only the capture but the billable activity as well, with services un-billable through 2025 unless the patient sent readings on at least 16 days of a given month. Only 62% of enrolled patients reached that 16 day threshold in at least two of their first three months, according to a 2026 study in the Journal of General Internal Medicine. (Since 1 January 2026 a new code pays for 2 to 15 days, which of course ought to help, but the change is too new for published impact data to be available.)
The payments reflect the same erosion. Billing the full set of monitoring codes for a year would bring in about $1,200 to $1,700 per patient at 2026 rates. In reality Medicare paid an average of $545 per enrolled patient in 2022, according to the HHS Office of Inspector General.
Chronic care management
Chronic care management reaches even fewer patients: only 1.1% of eligible Medicare patients in 2015. By 2019, perhaps related to reduced paperwork requirements implemented in 2017 (McDonald Hopkins, Nov. 15, 2016), participation had risen to 3.4% according to a 2024 study in the Journal of the American Geriatrics Society, but that’s still only one eligible patient in thirty. And here again, attrition is extreme. A 2017 evaluation for CMS by Mathematica found that 19% of patients who used the service received it for just one month. APCM (codes G0556 to G0558) is a newer version of CCM, beginning on 1 January 2025, and remains too new for any sufficiently large, published accounting of results we could find, but there’s no obvious reason to expect uptake and attrition to differ radically from CCM.
Annual wellness visit
The uptake history of annual wellness visit shows how difficult closing a gap can be even when the obvious obstacles are removed. The visit has been free to patients since 1 January 2011 and has been heavily promoted. In 2011, only 7.5% of eligible patients had one. Heavy promotion drove uptake to 15.6% in 2014 (Ganguli 2017), 18.8% in 2015 (Ganguli 2019) and 37.3% in 2019 (Zhang 2025). Table 1 shows 38.14% in 2024. So even after fourteen years, only about one eligible patient in three gets the visit. Even worse, initial wellness visits declined by roughly a third then stayed flat even as follow-up visits for already captured patients grew. The good news is that most patients who came in for a first annual wellness visit kept coming back year after year, Gabbard 2024, Morgan 2021, which is both excellent medicine and revenue baked into the annual bottom line. The bad news is that those repeat visits are already included in the percentage receiving the service, which puts them outside the gap a practice could capitalize on. It’s not new revenue, in other words.
Software Fees and Labor Further Degrade or Eliminate the Revenue Potential of RPM & CCM
Table 1 accounts for required investment in equipment and software. It also considers necessary procedure counts. It does not account explicitly for staff time—labor in hours. If it did, remote monitoring and chronic care management would suffer worst, and badly, because adding both services consist mainly in adding staff time. By definition, both services are billed by staff labor. Code 99457 pays for the first 20 minutes each month that clinical staff spend on a remote-monitoring patient. Code 99490 pays for the first 20 minutes each month of clinical staff time on chronic care management. That additional work is done outside the exam room and repeats every month the patient stays enrolled.
That labor severely degrades or eliminates profit, if only by opportunity cost. For economies of scale a clinic can contract this work out, paying $40 to $80 per patient per month for RPM, according to HealthArc, and $18 to $28 for CCM, according to Mindbowser. Using the middle of those price ranges, RPM bills $113,882 and the vendor charges $151,697, a loss of $37,815, where Table 1 shows a gain of $50,700. CCM bills $58,560 and the vendor charges $53,058, which leaves only $5,502 of the $49,330 shown on Table 1. A clinic that keeps the labor in-house spends at least 391 hours per 100 pts over three years on RPM, and about 325 hours on CCM. That is roughly ten and eight 40-hour weeks in which those staff can’t bill anything more lucrative.
The software accounting, while baked into Table 1 at a theoretical per patient level, is more corrosive to revenue in actual practice. RPM software costs $6 to just under $50 per enrolled patient per month, and Table 1 uses $25. At $25, software eats 55 cents of every dollar Medicare pays. At $40, it takes 89 cents. Further, device and connection fees are charged for every enrolled patient, every month, regardless of whether that patient reaches the 16 day threshold for billing that month, 38% of whom typically don’t. That mismatch helps explain why Medicare paid only $545 per enrolled patient.
Allergy testing’s own staff time
In stark contrast to RPM and CCM, allergy testing takes little staff time, and it’s only one procedure one time for each patient. Depending on allergy panel size, a medical assistant applies four to ten prepared applicators in minutes and leaves the room during the 15-minute wait. The MA then spends perhaps ten minutes measuring and recording the results. Non-clinical staff can do the recording and loading the wells, which serves multiple tests and takes no clinical skill or credentials. Thus, Table 1 counts 28 tests per 100 active patients over three years which adds up to well under ten hours total, and more like five, compared to 10 weeks for RPM.
What This Means for the Comparison
For purposes of full disclosure and maximal conservatism in comparing to allergy testing, Table 1’s two largest rows rest on an assumption no published study has come close to meeting: that a practice can enroll every eligible patient. Both rows also carry staff costs that Table 1 leaves out. The wellness visit, fourth on the table, is also unrealistic but to whatever extent it can be captured it works in allergy testing’s favor by creating more annual screening opportunities.
Allergy testing needs no capital, no software and no per-patient fee. It takes under a week of assistant time per 100 active patients over three years, and it draws on patients the practice already has.