Medicare Missed-Revenue Kit · CY2026
Find the Medicare work your practice already does and never bills.
Wellness visits that weren't scheduled. Advance care planning talks with no time documented. Care-management calls with no consent on file. Discharges nobody heard about until it was too late for TCM. I made this kit to find those gaps in my own practice. It's a plain-English guide plus a spreadsheet that does the math for you.
Practice manager, small primary care practice
What it covers
The services I see slip through most
For each one the guide spells out who qualifies, how often, what to document, which modifier, and why claims get denied. Rates below are copied from the kit: 2026 national, non-facility, unadjusted Medicare allowed amounts. Yours will vary by locality.
| Service | Code(s) | 2026 national | Where it usually gets lost |
|---|---|---|---|
| Annual Wellness Visit | G0438 / G0439 | $174.35 / $137.61 | Frequency denials, and visits nobody scheduled. |
| Advance care planning | 99497 (+ mod 33 with AWV) | $86.84 | The conversation happens; the time and "voluntary" never get documented. |
| Chronic care management | 99490 | $66.13 / month | Between-visit calls happen anyway. No consent, care plan or time log, so nothing is billed. |
| Principal care management | 99424 / 99426 | $87.51 / $67.80 | Patients with one serious condition who don't fit CCM. |
| Advanced primary care mgmt | G0556–G0558 | $16.37–$117.24 / month | Practices that hate minute-tracking never look at it. |
| Remote monitoring (RPM) | 99445 / 99470 (new 2026) | $52.11 / $26.05 | Short months (2–15 data days, 10–19 minutes) are billable now. |
| Transitional care mgmt | 99495 / 99496 | $220.11 / $298.60 | The discharge isn't noticed within 2 business days. |
| Visit complexity add-on | G2211 | $17.37 per visit | Charge templates never prompt for it. |
Also covered: IPPE, G0136 (redefined for 2026), depression and alcohol screening, CVD and obesity counseling, complex CCM, and cognitive assessment and care planning (99483). Source: CMS CY2026 PFS Relative Value File (RVU26D) × $33.4009.
What's inside
Three files, one download
1. The guide
15 pages, PDF. The rules for each service in plain English, a quick-reference rate table, a common-denials table, a 30-day action checklist, a 2027 watch list and a full CMS sources page.
2. The self-audit workbook
Excel .xlsx, no macros. Enter de-identified counts and it estimates annual missed revenue for 17 services, with a dashboard, your top 3 opportunities and a chart. Every rate can be edited for your MAC locality.
3. The quick reference
1 page, PDF. Seven Medicare services small practices often do but don't bill, with the 2026 rate and the common miss for each, plus a 15-minute check you can run on your own charge report.
Page by page
| p. 1–2 | How to use the kit, and exactly how every dollar figure was calculated |
| p. 3 | Quick reference: 30+ codes with frequency limits, cost share and 2026 national rates |
| p. 4 | Annual Wellness Visit and IPPE: eligibility, required elements, billing it right |
| p. 5 | Advance care planning (99497/99498) and the redefined 2026 G0136 |
| p. 6 | Screenings and behavioral counseling: depression, alcohol, CVD and obesity IBT |
| p. 7 | G2211 and the modifiers that matter (25, 33, telehealth POS and modifiers) |
| p. 8 | Chronic care management and principal care management |
| p. 9 | Advanced primary care management (APCM), including the 2026 behavioral health add-ons |
| p. 10 | Remote physiologic monitoring in 2026, including new codes 99445 and 99470 |
| p. 11 | Transitional care management and cognitive assessment and care planning (99483) |
| p. 12 | Common denials and how to prevent them |
| p. 13 | A 30-day action checklist, week by week |
| p. 14 | 2027 watch list: what CMS has proposed (not final) |
| p. 15 | Every CMS source used, with links, plus the full disclaimer |
How the self-audit works
Counts in, a ranked list out
- Pull 12 months of counts. From your practice-management system: how many of each code you billed, plus a few totals like active Medicare patients, patients with 2+ chronic conditions and hospital discharges. Totals only. No names, birthdates or MBIs.
- Type them into the yellow cells. The Inputs tab has 27 of them, most with a note on where to find the number. It ships with a sample practice filled in so you can see how it behaves first.
- Adjust the assumptions if you want. Blue cells hold conservative targets, like what share of eligible patients you could realistically see for a wellness visit. Change them to fit your capacity.
- Read the Dashboard. Estimated annual missed revenue, a monthly average, your top three opportunities and a chart. The Calculator tab shows every formula, so nothing is a black box.
Optional: switch between facility and non-facility rates, or type your MAC's locality fee to override the national rate for any code.
A worked example, using the made-up practice in the file: 800 Medicare patients, 30 of them new to Medicare, 260 wellness visits billed last year. At a 70% target, that's (800 − 30) × 0.70 = 539 visits. Minus the 260 already billed leaves 279, times $137.61 for a subsequent AWV, about $38,393 a year. Same logic for each of the 17 services. It's an estimate, not a promise; your counts, locality and documentation decide the real number.
Who it's for
Small practices that bill Medicare Part B
- Independent primary care, family medicine and internal medicine practices
- Geriatric practices and practices with a large Medicare panel
- Practice managers and billers who want to know where to look first
- Small billing companies that serve those practices
Who it's not for
Being straight with you
- If you need a certified coder to audit your charts, this isn't that. It points you to where to look.
- If most of your patients are on Medicare Advantage, those plans set their own rules.
- FQHCs and RHCs are paid under their own methods; the guide notes the differences but is written for fee-schedule practices.
Medicare Missed-Revenue Kit 2026
$24
- 15-page CY2026 guide (PDF)
- Excel self-audit workbook (.xlsx, no macros)
- 1-page quick reference (PDF)
- License for one practice, all staff under one tax ID
- Questions about a file? Email me
Checkout is handled by Payhip, with payment through Stripe or PayPal. You'll get a download link on screen and by email.
JennyQuestions
Before you buy
Is this affiliated with CMS or Medicare?
No. I'm an independent practice manager. The kit summarizes public CMS material as of October 2026 and cites every source. It's an educational reference, not legal, coding or billing advice, and it doesn't guarantee payment. Always confirm with your MAC before you change how you bill.
Is it current for 2026?
Yes. It's Edition 2026.1 (October 2026). Rates come from the CMS CY2026 Physician Fee Schedule relative value file (RVU26D) multiplied by the CY2026 conversion factor of $33.4009. It covers the 2026 changes: the redefined G0136, new RPM codes 99445 and 99470, G2211 on home visits, and the APCM behavioral health add-ons.
What happens when the 2027 rules come out?
Page 14 lists what CMS has proposed for 2027, clearly marked as not final. The kit says buyers of this edition get an updated 2027 rate table and rule summary after the final rule is published, and I'll email it to the address you used at checkout.
Do I need to enter patient information?
No, and please don't. The workbook only asks for totals, like "800 Medicare patients, 260 wellness visits billed." It has no macros, makes no network connections and doesn't send data anywhere.
Will it work on my computer?
The guide and quick reference are PDFs. The workbook is a standard .xlsx file that opens in Excel, Google Sheets and free LibreOffice. Download on a computer, not a phone, so you can unzip it.
Can I share it with my staff?
Yes. The license covers one practice, meaning all staff under one tax ID. Please don't pass it to other practices or post it online.
Is this for Medicare Advantage too?
The kit covers Original Medicare (Part B fee-for-service) under the Physician Fee Schedule. Medicare Advantage plans set their own rules. FQHCs and RHCs are paid differently, and the kit notes where.
What if a file won't open?
Email me. If a file won't open, is corrupted, or you were charged twice, I'll fix it or make it right. Because it's an instant digital download, sales are otherwise final. Download policy.
Why does checkout say Plainchart Guides?
That's the name I started under. I'm moving everything over to Clinic Revenue Guides, and the files and checkout page still carry the old name for now. Same person, same files.
Something I didn't answer? Email me: jenny@clinicrevenueguides.com