MSK Access
A program byRevelAi Health
CMS ACCESS Model · MSK Co-Management

What co-management is worthto your care organization.

Start with the co-management revenue your clinicians can earn on the CMS ACCESS Model. Then add the downstream physical therapy and clinical volume from enrolled patients whose care reviews surface a need for a visit. Every number below is adjustable, grounded in the 2026 Medicare Physician Fee Schedule, and cited.

No cost to your organization — data-use agreement only. You keep full FFS billing rights.
Older adult walking pain-free with a physical therapist at golden hour
How the payment adds up

Up to ~$100 per co-managed patient, per year

Per the ACCESS Model RFA (Dec 2025), co-managing clinicians bill a new ACCESS G-code — paid FFS through your MAC — for a documented ~5-minute review of each ACCESS Care Update. No beneficiary cost-sharing applies. Amounts are approximate national base rates, geographically adjusted like the rest of the fee schedule.

$30
Per co-management review
Billable once every 4 months — up to 3× per year ($90)
+
$10
Onboarding modifier
One-time add-on to your first co-management claim
→
~$100
Per patient / year
Year-one cap at full cadence; ~$90/yr thereafter

Your assumptions

Defaults are illustrative and sourced. Replace them with your own panel data.
patients
Assumption: traditional-Medicare patients with chronic MSK pain (>3 months) — the MSK track's qualifying condition.1 Chronic pain affects 30.0% of adults 65–84 and 34.3% at 85+ (CDC, 2021 data),6 and it is most often musculoskeletal — within an established MSK patient base the qualifying share is far higher. Replace with your own roster.
%
Assumption: ~10% is a conservative base. Roster-based outreach with clinician endorsement moves it up — the sensitivity table below shows 5–25%.
Assumption: ~$30 per documented review (billable once every 4 months, up to 3×/yr) + ~$10 one-time onboarding modifier = $100 per enrolled patient in year one.1
Downstream PT revenue
%
Assumption: share of enrolled patients who end up needing a virtual or in-person PT visit — typically 10–15%. This is your group's own FFS revenue.
visits
Assumption: 6.8 = mean visits (SD 4.7) per outpatient PT episode among Medicare beneficiaries with MSK conditions (Fritz et al., Physical Therapy, 2011).5 Set to your own episode data.
$
Assumption: at 2026 national non-facility rates, a PT evaluation (97161) pays ~$98 and a 3–4-unit treatment visit runs ~$85–$100 (97110 $29.06, 97140 $27.72, 97530 $35.07 per 15-min unit; conversion factor $33.40).3 Varies by CPT mix, MPPR, and locality. At defaults this is $612 in FFS revenue per returning patient.
Downstream clinical volume
%
Assumption: share of enrolled patients whose care review surfaces a need for an in-clinic evaluation — specialist consult, injection, imaging follow-up. Set from your own referral experience; this is your organization's ordinary FFS volume, not an ACCESS payment.
$
Assumption: one new-patient evaluation (99204, $177.36) + one follow-up visit (99214, $135.61) = $313 at 2026 national non-facility rates.4 Add $68.81 where a major-joint injection (20610) is indicated; procedures, imaging, and surgical episodes are additive and not modeled here.

Revenue to your care organization

Annual, at your assumptions. Illustrative only.
Co-management revenue—
+ Downstream PT revenue (FFS)—
+ Downstream clinical volume (FFS)—
Total annual revenue—
—
Enrolled patients
—
Co-management fee / patient / yr
—
Patients needing a PT visit
—
FFS revenue / PT episode
—
Patients needing a clinician visit
—
FFS revenue / clinical episode
Enrollment sensitivity

What enrollment rate does to the number

Current panel and assumptions, varying only the enrollment rate. Your current scenario is highlighted.

EnrollmentEnrolledCo-managementDownstream PTClinical volumeTotal
Grounding

Assumptions & sources

Every number in this calculator, where it comes from, and what to replace it with.

1
Co-management payment — up to ~$100/patient/yr.CMS Innovation Center, Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, Request for Applications (Dec 19, 2025), pp. 31–32: the Co-Management service is "paid at approximately $30 per service," billable "once every four months per beneficiary per track, up to approximately $100 per year," plus a one-time onboarding modifier of "approximately $10." Billed via a new G-code (to be published in 2026), adjusted by the PFS Geographic Adjustment Factor and standard Medicare payment adjustments (including sequestration and non-physician-practitioner reductions). No Part B beneficiary cost-sharing. CMS may adjust amounts in later years.
2
2026 Physician Fee Schedule conversion factor — $33.40.CY 2026 PFS final rule (90 FR, Nov 5, 2025), effective Jan 1, 2026. Two conversion factors apply for the first time: $33.57 for qualifying APM participants and $33.40 otherwise — both a 3.26% increase over 2025. All dollar rates on this page use the $33.40 non-QP factor.
3
PT payment rates — 2026 national non-facility.PT evaluation (97161) ≈ $98; therapeutic exercise (97110) $29.06, manual therapy (97140) $27.72, and therapeutic activities (97530) $35.07 per 15-minute unit — so a typical 3–4-unit treatment visit pays ~$85–$100. Verify any code and locality with the CMS Physician Fee Schedule lookup tool. Actual payment reflects GPCI adjustment, the multiple-procedure payment reduction on therapy practice expense, and PTA-modifier reductions where applicable.
4
Clinical visit rates — 2026 national non-facility.New-patient office visit 99204 $177.36; established follow-ups 99214 $135.61 and 99213 $95.19; major-joint injection 20610 $68.81 (CMS PFS lookup, conversion factor $33.40). The $313 default episode = one 99204 + one 99214; injections, imaging, and any surgical episodes are additive and deliberately excluded to keep the estimate conservative.
5
Visits per PT episode — 6.8.Fritz JM, Hunter SJ, Tracy DM, Brennan GP. Utilization and clinical outcomes of outpatient physical therapy for Medicare beneficiaries with musculoskeletal conditions. Physical Therapy. 2011;91(3):330–345 — mean 6.8 visits (SD 4.7) per episode. Substitute your organization's own utilization data.
6
Eligible panel — chronic pain in the Medicare-age population.Rikard SM, Strahan AE, Schmit KM, Guy GP. Chronic pain among adults — United States, 2019–2021. MMWR. 2023;72(15):379–385 — chronic pain (>3 months) affects 30.0% of adults 65–84 and 34.3% of adults 85+, and is most commonly musculoskeletal. The ACCESS MSK track's qualifying condition is chronic MSK pain lasting more than three months (RFA, Table 1). Within an established MSK patient base the qualifying share is far higher — replace the default with your active Medicare roster.
7
Enrollment rate and visit-conversion rates — planning assumptions.The 10% enrollment, 12% PT-visit, and 6% clinician-visit defaults are RevelAi planning assumptions, not published statistics — they are the inputs to pressure-test with your own data. Roster-based outreach with clinician endorsement typically outperforms cold outreach; the sensitivity table brackets the enrollment range.
8
Program structure — no cost to the co-managing organization.RevelAi Health is the ACCESS Model participant; your organization is the co-managing partner under a data-use agreement. RevelAi handles outreach, enrollment, eligibility queries, and care-navigator supervision. Your organization retains full FFS billing rights. No figure above includes any ACCESS-participant (RevelAi) revenue.
All figures are illustrative. Dollar amounts are 2026 national rates before geographic adjustment, the 2% sequestration reduction, MPPR, and assistant-modifier reductions. ACCESS co-management amounts are approximate per the RFA and subject to CMS revision. Downstream PT and clinical volume are ordinary FFS billing contingent on medical necessity — the ACCESS Model does not pay for, require, or guarantee referral volume. This page is not billing, legal, or coverage advice.