> For clean Markdown of any page, append .md to the page URL.
> For a complete documentation index, see https://blueprint.ziro.health/llms.txt.
> For AI client integration (Claude Code, Cursor, etc.), connect to the MCP server at https://blueprint.ziro.health/_mcp/server.

# Pricing & Reimbursement

Getting paid in healthcare requires navigating a complex reimbursement landscape. Your pricing strategy must account for who pays, how they pay, and what evidence they need to justify payment.

## Reimbursement Pathways

| Pathway                   | How It Works                           | Best For                         |
| ------------------------- | -------------------------------------- | -------------------------------- |
| CPT codes                 | Established codes for defined services | RPM, telemedicine, coaching      |
| Digital therapeutic codes | Emerging codes for DTx products        | FDA-cleared digital therapeutics |
| B2B SaaS subscription     | Per-month or per-member pricing        | Health system tools              |
| B2C subscription          | Patient self-pay                       | Wellness, fitness, mental health |
| Employer/plan sponsorship | Paid by employer or insurer            | Chronic care, wellness           |
| Value-based arrangement   | Payment tied to outcomes               | Population health                |

## B2B vs B2C Pricing Models

| Aspect            | B2B (Health systems)                  | B2C (Patients)       |
| ----------------- | ------------------------------------- | -------------------- |
| Buyer             | Budget holder, procurement department | Individual patient   |
| Price sensitivity | ROI-based                             | Cost-sensitive       |
| Contract          | Annual, multi-year contracts          | Monthly subscription |
| Implementation    | 3-6 month procurement cycle           | Immediate            |
| Churn             | Low (contract-based)                  | High                 |
| Revenue           | Higher, predictable                   | Lower, variable      |

## Digital Therapeutics Coding

Emerging reimbursement codes for digital health:

* **American Medical Association (AMA)** : Digital health CPT codes for various digital health services
* **HCPCS codes**: Level II codes for devices and supplies
* **CMS reimbursement**: Medicare coverage decisions for digital health
* **Private payer coverage**: Varies by payer, increasingly covering digital health

## Pricing Strategy Considerations

* **Value-based pricing**: Price proportional to value delivered (cost savings, outcome improvement)
* **Tiered pricing**: Basic, premium, enterprise tiers
* **Per-member pricing**: PMPM model aligns with health system budgets
* **Implementation fees**: One-time setup and integration costs
* **Success fees**: Bonuses for outcome achievement