CMS details ACCESS co‑management payment: $30 per review, up to three times per year; $10 onboarding add‑on

CMS presenters described how primary care and other eligible clinicians can bill a co‑management payment (CMP) when they review an ACCESS care update and document related care coordination.

"The co-management payment or CMP is payable for one unit of service, requiring a minimum of five minutes of clinician time spent reviewing an access care update and performing any associated care coordination activity," said Coleman Adams, Access Model payment lead. Presenters said CMS will pay 100% of the Medicare‑allowed amount for CMP services because beneficiary cost sharing does not apply.

Key billing rules presented:
- One CMP unit requires at least five minutes of documented clinician review and a brief written note capturing any care coordination action (for example, medication reconciliation, problem‑list updates or referrals).
- CMPs are payable up to three times per 12‑month care period per beneficiary per access track; clinicians may bill separately for distinct tracks if separate coordination activities occur.
- CMS indicated a national rate of about $30 per CMP service, subject to geographic adjustment; clinicians who provide onboarding and setup assistance may bill an initial onboarding modifier for an additional $10 (both amounts are subject to adjustment under the Medicare physician fee schedule).
- Certain provider groups (FQHCs, RHCs, and pharmacies with pharmacists) will be able to bill under Medicare beginning October 2026; other eligible clinicians may begin billing at model launch in July 2026.

Claims must include documentation tying the date of service to the documented review, appropriate place of service, a diagnosis code corresponding to the beneficiary’s qualifying track (per the implementation guide), and the billing clinician’s NPI and billing TIN. Presenters warned that claims with G‑codes not matched to a corresponding track diagnosis code will be denied.

Presenters also explained that if a PCP never receives an access care update, that clinician cannot bill the CMP; a documented review of an electronically shared care update is a billing prerequisite.