As of January 1, 2025, CMS officially launched Advanced Primary Care Management (APCM) services - designed to help primary care practices simplify billing and get paid for delivering comprehensive, ongoing care to Medicare patients.

If you provide primary care services, especially to patients with chronic conditions, APCM could be a major win for both patient care and your bottom line. But the key is understanding how to bill for it correctly.

What Is APCM? APCM bundles together various chronic care services - like care coordination, patient outreach, remote communication, and preventive care planning - into a single, monthly service. Unlike traditional care management codes, APCM billing is not time-based, so you don’t have to document every minute of care.

You can bill once per patient per calendar month, as long as you meet the clinical requirements.

Who Can Bill for APCM? To bill for APCM, you must:

• Be a physician or non-physician practitioner (NP, PA, CNS)
• Provide all of the patient’s primary care services
• Be the focal point for their overall healthcare
• Obtain verbal or written consent from the patient

APCM codes are primarily intended for primary care specialties, such as:

• Family medicine
• General internal medicine
• Geriatrics

Which APCM Code Do You Use?

There are three HCPCS codes for APCM. Choose based on the complexity of the patient:

• G0556 ($15 per patient per month): For general APCM services by clinical staff under physician direction.
• G0557 ($50 per patient per month): For patients with 2+ chronic conditions.
• G0558 ($110 per patient per month): For Qualified Medicare Beneficiaries with 2+ chronic conditions

Each level includes the core elements listed under G0556, with added requirements depending on the patient’s condition and status.

What Are the Core Billing Requirements?

To bill APCM codes, providers must deliver several key services (when clinically appropriate), including:

• Patient consent(once per patient, documented in the record)
• Initiating visit (required unless the patient was seen in the past 3 years or had care management services in the last year)
• 24/7 access to care team and real-time medical information
• Comprehensive care plan, shared with the patient and updated routinely
• Medication reconciliation & preventive care
• Care coordination, especially post-hospital/SNF or ED discharge
• Population health management (identify care gaps, risk stratify)
• Performance reporting, such as MIPS MVP or ACO participation
• Use of digital communication tools, including patient-initiated messaging or remote consults

Note: Auxiliary personnel may provide APCM services under general supervision, so long as they meet Medicare’s criteria for “incident to” services.

Why APCM Is a Game Changer

Traditional care management codes are time-based and complex. You must track every minute and hit specific thresholds to bill. APCM is different:

• Not time-based
• Once-a-month billing
• Simplifies chronic care workflows
• Supports value-based care participation

Ready to Get Started? As healthcare continues to move further into value-based care, APCM offers a new opportunity to improve outcomes while earning reimbursement for services you're likely already providing.

Let Quantician help you make reporting and billing transitions smooth and effective. Contact us today to learn how we can handle your APCM claims and billing needs.