The revenue engine of the clinical model. Same-visit blood chemistry eliminates the 48-hour send-out lab delay that blocks same-visit medication decisions. CLIA-waived for standard cartridges. Unlocks moderate complexity panels (BNP, Troponin, Blood Gas) at Month 2–3 after Certificate of Compliance is received. Net lab margin after cartridge COGS: ~$14/BMP test, ~$6/HbA1c test.
Bills: BMP · HbA1c · INR panels — est. $180–240K/yr at full panel

Required at every Annual Wellness Visit and for any cardiac complaint. AF affects approximately 10% of adults over 80 — most cases go undetected before a clinic-based ECG catches them. QTc monitoring is mandatory for patients on fluoroquinolones, antipsychotics, amiodarone, and azithromycin. AliveCor Kardia 12L is AI-powered and well-suited to rotating between exam rooms.
CPT 93000 · ~$20/study · ~750 ECGs/yr = ~$15K/yr at full panel

Medical-grade CDC/ACIP-compliant refrigerator with continuous electronic temperature datalogger. All four priority vaccines covered by Medicare Part B at zero patient cost-sharing, which drives high acceptance rates in this population. Shingrix (2-dose series) carries approximately $45 margin per dose before the administration fee. VAERS reporting required. VFC eligibility check for dual-eligible members.
Part B billing — vaccine + administration code per antigen

Portable compressed-air nebulizer for albuterol 2.5 mg unit-dose treatment. COPD affects roughly 32% of rural Georgia FFS seniors — acute bronchospasm is one of the most frequent urgent presentations. On-site treatment prevents ambulance transfer and ED admission. PARI Trek S or Omron MicroAir recommended. Escalation criteria (SpO2 below 92% after 2 treatments = transfer) must be in a standing order before clinic opens.
CPT 94640 · ~$18/treatment

CLIA-waived lateral flow antigen kits for Influenza A/B, Strep A, and COVID-19. Provides Day 1 rapid testing capability before the Cue Health multiplex device arrives at Month 3. Strep A testing continues year-round — not covered by the Cue Health panel. COVID and flu antigen serve as lower-cost alternatives when multiplex PCR is not indicated. Seasonal volume spike runs October through April.
CPT 87880 (Strep) · 87804 (Flu) · 87811 (COVID)

The i-STAT does not perform dipstick urinalysis — this is a separate, required instrument. UTI is the leading cause of hospitalization in elderly women, making this a material clinical need on Day 1. Siemens Clinitek Status+ or Roche Urisys 1100 produces an objective digital 10-parameter result, eliminating color-comparison variability under exam room lighting. Positive leukocyte esterase + nitrites triggers a Quest/LabCorp urine culture send-out. CLIA-waived.
CPT 81003 · ~$11/test

No E&M visit can be billed without documented vitals — this station makes every office visit billable. Combining automated BP (standard + large adult + thigh cuff sizes), pulse oximeter, digital thermometer, and a 550-lb capacity scale. LPN captures all four measurements before the NP enters the room, compressing intake to under 3 minutes. Welch Allyn Connex Spot Monitor integrates all four with Bluetooth sync to the EHR, eliminating manual transcription. Calibration logs required for CLIA compliance.

CMS requires visual impairment detection as a named element of the Annual Wellness Visit — its absence leaves G0438/G0439 documentation incomplete and the claim vulnerable to audit clawback. Snellen chart documents acuity; Amsler grid is a 90-second test for wavy or missing lines indicating AMD or diabetic macular edema. Georgia legal driving threshold is 20/40 in the better eye — document and counsel accordingly. Amsler grid distortion warrants urgent ophthalmology referral within 1–2 weeks.
AWV component: G0438 / G0439

ADA standards require a monofilament neuropathy screen at every diabetic visit. 10-gram Semmes-Weinstein monofilament pressed against 10 standardized plantar surface sites; 128 Hz tuning fork at the great toe and medial malleolus. Loss of protective sensation is the primary predictor of diabetic foot ulceration and amputation in this population. Results drive podiatry referral, therapeutic footwear documentation (A5500 series, Medicare-covered with neuropathy diagnosis), and HCC coding. Replace monofilaments every 6–12 months.
HCC: E11.40 series · therapeutic footwear: A5500

5,000–6,500K color temperature LED at daylight-equivalent spectrum accurately represents tissue color for wound bed assessment and skin lesion evaluation. Flexible gooseneck positions the beam at any anatomical site without shadow. Adjustable intensity: full brightness for wound debridement; reduced for eye examination. One at each exam table and one at the procedure station. Hands-free operation allows two-handed procedures without a second person holding the light. This item is consistently cited as a gap in clinic buildouts that skip it.

CMS explicitly requires detection of cognitive impairment as part of the AWV. The Montreal Cognitive Assessment (MoCA) is a 10-minute, 30-point screen across 8 cognitive domains, with 90% sensitivity for mild cognitive impairment — significantly more sensitive than the older MMSE (~18%). Score below 26 triggers B12, TSH, CBC, and BMP workup plus anticholinergic medication review. License available from mocatest.org at ~$75–200/yr. Canvas has MoCA integrated as a structured form.
CPT 96125 (~$75 when clinician interprets) · HCC: F06.70 / F03.90

CMS requires functional ability and safety review at the AWV. The CDC STEADI protocol consists of three components: (1) Stay Independent Brochure — 12-question patient self-report, (2) Timed Up-and-Go test — rise from chair, walk 10 feet, return; above 12 seconds indicates high risk, (3) 4-Stage Balance Test and 30-Second Chair Stand. LPN administers during intake. High-risk patients trigger PT referral, vitamin D assessment, and medication fall-risk review. Materials free at CDC.gov/STEADI in English and Spanish.
AWV component: G0438 / G0439 · STAR measure: falls screening

CMS requires depression screening as a named component of the Annual Wellness Visit. PHQ-9 (9-item depression screen, 0–27) and GAD-7 (7-item anxiety screen, 0–21) are both public domain and free as paper forms — the EHR has both built in with auto-scoring. PHQ-9 sensitivity and specificity at ≥10: 88% for major depressive disorder. PHQ-9 Question 9 (suicidal ideation) positive requires a documented safety assessment protocol — this protocol must be written and in place before the first AWV is performed.
CPT 96127 · ~$18/screen (separate from E&M)

The Montreal Cognitive Assessment (MoCA) is a licensed instrument — clinical use requires an annual license from mocatest.org regardless of whether it is administered on paper or via an EHR-integrated form. Confirm with your EHR vendor whether their embedded MoCA form includes the license fee or requires a separate agreement with the MoCA organization. Budget as an annual OpEx item. Small dollar amount but a real launch prerequisite — do not administer without the license in place.
CPT 96125 (~$75 when clinician interprets) · license: mocatest.org

OSHA 29 CFR 1910.1030 requires sharps containers at every needle-use location and a licensed hauler contract before the first patient. Georgia EPD regulates medical waste generators. Point-of-use sharps containers (1-quart at each needle station, 2-gallon at the lab area), red-bag biohazard soft waste containers, leakproof exterior transport container, and documented waste manifests. Hauler contract with Stericycle, US Ecology, or Sharps Compliance required before launch — typically $60–120/month for small-generator pickup. Pharmaceutical waste is a separate disposal stream.

Three-component system required before any medication is stored on-site: (1) locked steel cabinet for Rx samples and OTC supplies, (2) DEA Schedule II-compliant combination safe bolted to the building structure with a daily access log — required if any controlled substances are stocked, (3) medical-grade refrigerator at 2–8°C with continuous electronic temperature datalogger. Georgia PDMP query required before prescribing any controlled substance. DEA clinic address registration must be completed before stocking controlled substances. Temperature excursion above 8°C for more than 1 hour = do not administer stored vaccines.

Height-adjustable, bariatric-rated exam tables required for every clinical encounter. The 500-lb weight rating is non-negotiable given the rural Georgia Medicare FFS population BMI profile. Hydraulic height adjustment eliminates staff musculoskeletal injury risk across 10+ patient transfers daily. Stirrups and leg rests extend scope to pelvic and genitourinary exams. Midmark 626 and Brewer are the two most widely deployed clinical exam table lines. Bolted to clinic floor per OSHA requirements.

Required for Medicare clinic operation. ADA-compliant entry ramp at 1:12 maximum slope, accessible restroom with 60-inch turning radius, grab bars, and accessible fixture heights, van-accessible parking space (8-ft wide + 8-ft access aisle), lever door handles throughout, and high-contrast tactile signage at all rooms and exits. Confirm responsibilities in the lease before signing — retail-to-clinic conversions frequently require tenant improvement work. Recommend a Certified Access Specialist (CASp) review before lease execution.

Four ruggedized tablets (iPad Pro or Surface Pro) in desk or wall mounts for the NP, LPN, front desk, and care coordinator stations. Offline mode must be validated before launch. HIPAA screen positioning required — screens face away from patient flow in all areas. MDM enrollment via Rippling for HIPAA endpoint configuration. All four devices enrolled and tested before the first patient day.

Fiber broadband primary with managed firewall and HIPAA-grade network segmentation. Guest Wi-Fi VLAN separated from the clinical network; EHR and billing systems on an isolated segment. Cellular LTE failover (Cradlepoint or Peplink dual-WAN) provides under-30-second automatic failover — transparent to clinical workflow. Fiber installation lead time is 4–8 weeks — initiate during clinic buildout, not after. An ISP outage without failover costs an estimated $3–6K in lost clinic revenue per day.

Required under the HIPAA Security Rule's physical safeguards provisions. Interior and exterior cameras with remote monitoring capability, keycard or keypad entry control at the main door and medication storage area. Camera coverage must include all patient care areas, front desk, and medication storage — document coverage in the HIPAA security risk assessment. Footage retention of at least 30 days. DEA may require camera coverage of controlled substance storage during the clinic registration inspection.

Wireless thermal printer (Brother QL-820NWB or Zebra ZD230) for lab requisitions, medication labels, and after-visit summaries. Specimen tube labels with patient name, DOB, and collection time are required by Quest and LabCorp. Many rural Georgia elderly patients rely on paper visit summaries for caregiver communication — do not treat this as optional. EHR prints wirelessly without USB. Stock 2–3 thermal paper rolls per clinic day.

Passive 4G cellular gateway provisioned by the LPN at the first enrollment visit. The patient simply uses their device — the hub uploads readings automatically with no WiFi or smartphone required. Configurable alert thresholds (SBP above 180, weight gain above 2 lbs/24hr, SpO2 below 88%) trigger a care coordinator notification. Device COGS of approximately $55/enrolled member/month is deducted against RPM gross, yielding a net RPM margin of ~49%.
CPT 99453 + 99454 + 99457 + 99458 · est. $514–615K/yr at 400 enrolled members

Transport-only vehicle — not a mobile care delivery unit. Clinical hardware and connectivity infrastructure are not part of van cost modeling. Range $30K–$40K for a used 2–4 year old commercial cargo/passenger van. Wheelchair-accessible vehicle (WAV) conversion adds approximately $8K and is strongly recommended given the mobility profile of the rural elderly Medicare population. One driver per active clinic at $45K/year. Tracked via Samsara fleet management.

Full wrap with regulatory decals and professional installation. Clinic branding on the transport van is a passive community awareness driver in the service area — the van traveling through rural counties creates visibility that no digital channel reaches. Required regulatory decals include non-emergency medical transport designations as applicable by Georgia NEMT rules. Coordinate wrap design with signage before fabrication so visual identity is consistent across all patient touchpoints.

Replaces the Day 1 antigen flu and COVID kits for respiratory season (October–April) with PCR-equivalent sensitivity. Simultaneously detects Influenza A, Influenza B, COVID-19, and RSV from a single nasal swab in approximately 25 minutes. This differentiation matters clinically — RSV in elderly immunocompromised patients carries significantly different management implications than influenza. CLIA-waived. Strep A antigen rapid testing continues in parallel — the Cue Health panel does not cover Strep.
CPT 87631 (combo flu/COVID/RSV) · ~$112/panel

Single-probe whole-body ultrasound that attaches directly to a smartphone. At the panel size and chronic disease mix in this population — a high prevalence of CHF, DVT risk, and pleural pathology — point-of-care ultrasound eliminates the 3–7 day delay of send-out imaging and prevents multiple unnecessary ED transfers per month. Cardiac views (LV function, pericardial effusion), pulmonary (B-lines for CHF vs. pneumonia), and DVT screening (compression of femoral/popliteal). NP proctoring and training through Months 6–9.
CPT 76641 · 76604 · 93308 range — bundling rules apply; confirm with billing counsel

Spirometry is the diagnostic standard for COPD staging and medication titration. GOLD Guidelines require FEV1/FVC ratio below 0.70 post-bronchodilator to confirm diagnosis — without spirometry, COPD coding is clinically unsupported and vulnerable to audit. At approximately 15% of the panel having COPD or asthma indication, this device pays for itself in one to two months of use. Spirometry interpretation requires NP competency training — document in provider credentials file.
CPT 94010 · ~$22/test

Stocked station for dressing changes, wound debridement, and wound assessment documentation. The rural Georgia elderly diabetic population has a disproportionately high incidence of chronic wounds and post-surgical wound care needs — the nearest wound care center is often 40+ miles away. Basic wound care supplies: sterile gauze, irrigation syringes, wound measurement tools, saline, Dakin's solution, calcium alginate and foam dressings, and wound photography protocol in place. Wound culture swab if infection signs present — send to Quest.
CPT 97597 / 97598 (debridement) · 99213–99214 (wound assessment E&M)

Ankle-brachial index (ABI) below 0.9 confirms peripheral arterial disease; below 0.4 indicates critical limb ischemia requiring urgent vascular surgery referral. Non-compressible vessels (ABI above 1.3, common in long-standing DM) trigger a toe-brachial index test. PAD diagnosis (I73.9) supports HCC coding and drives antiplatelet and statin intensification plus supervised exercise therapy documentation. Standard of care for all members with DM + HTN — a large share of this panel. Formal printed ABI report is the referral documentation standard for vascular surgery.
CPT 93922 · ~$45/bilateral study

Warfarin remains the predominant anticoagulant in the rural elderly Medicare population — DOAC uptake is significantly lower than in urban practices, partly due to cost concerns. The i-STAT handles routine INR testing, but a dedicated CoaguChek provides backup during cartridge shortages or i-STAT maintenance, and enables point-of-care testing in the waiting room or transport van for members arriving directly from home. CLIA Certificate of Waiver covers both devices. Results in 1 minute. Therapeutic range documentation drives anticoagulation management HCC coding.
CPT 85610 · ~$15/test (CLIA CoW)