The Easiest, Most Predictable Monthly Revenue You’re Not Capturing

Discover Advanced Primary Care Management (APCM)

APCM is a new Medicare primary-care bundle that pays a monthly, non–time-based fee for proactive, continuous care across your entire Medicare panel—without minute-counting or “16-day device” rules. It was created to bundle work you already do between visits (care planning, coordination, outreach, transitions, population management) into a single monthly code.[1]

Key idea: APCM combines elements of CCM, PCM, TCM and certain communication-technology services into one monthly payment for advanced primary care—so you bill once per calendar month when requirements are met.[1]

What is APCM—Really?

APCM is a designated care-management service under the Physician Fee Schedule that bundles: chronic/principal care management, transitional care, and communication-technology services (virtual check-ins, remote evaluation of prerecorded information, interprofessional consults). It’s intended to simplify billing/documentation and fund “in-between-visit” care that keeps patients on track.[1]

Medicare’s public explainer for beneficiaries says APCM providers offer 24/7 access, personalized care plans, chronic care management, care coordination, transitional care, and medication management—all month long.[2]

Who Can Bill & How Often

  • Eligible billers: Physicians and non-physician practitioners (NP, PA, CNS) who serve as the focal point for a patient’s primary care. Auxiliary personnel may furnish services incident to under general supervision of the billing practitioner.[1]
  • Billing cadence: Once per patient per calendar month (choose the appropriate HCPCS code by complexity).[1]

The APCM Codes (choose 1 per month by complexity)

G0556

Base APCM requirements furnished by clinical staff under the directing practitioner responsible for all primary care.[1]

G0557

Patient has ≥2 chronic conditions (lasting ≥12 months or until death and posing significant risk); includes G0556 requirements.[1]

G0558

Qualified Medicare Beneficiary (QMB) with ≥2 chronic conditions; includes G0556 requirements.[1]

Rates vary by locality. Use the official PFS Look-Up Tool to see current payment amounts for G0556–G0558 in your MAC and locality.[3]

What Medicare Expects You To Have “Available” Each Month (core billing requirements)

You don’t have to deliver every item to every patient monthly—but your practice must be capable of delivering these services and document them when used:

  1. Consent: Inform the patient that only 1 provider may bill APCM per month; they can stop anytime; cost-sharing may apply. Document once and keep on file.[1]
  2. Initiating visit (when needed): For new or not-seen-in-≥3-years patients (or if no recent care-management service in the past year). An AWV can qualify when performed by the responsible practitioner.[1]
  3. 24/7 access & continuity: After-hours urgent access to a team member with real-time chart access; ability to book successive routine visits with the same team member; extended/home visits as appropriate.[1]
  4. Comprehensive care management: Needs assessments (medical/psychosocial), preventive services navigation, medication reconciliation/oversight.[1]
  5. Electronic, patient-centered care plan: Living plan accessible inside/outside the practice; routinely updated; copy to patient/caregiver.[1]
  6. Care transitions: Timely exchange of information and follow-up with patient/caregiver within 7 days of ED/hospital/SNF discharge or visit.[1]
  7. Practitioner/home/community coordination: Ongoing communication and documentation with specialists, home health, and community services.[1]
  8. Enhanced communication options: Asynchronous, non-visit tools (secure messaging/portal/email), remote review of prerecorded info, interprofessional e-consults, e-visits/virtual check-ins.[1]
  9. Population analytics & risk stratification: Identify care gaps; risk-tier panel to target services.[1]
  10. Performance measurement & reporting: Primary-care quality, total cost of care, and use of CEHRT; report via the Value in Primary Care MVP (reporting in 2026 for CY2025) or participate in an ACO/other model.[1]

Why APCM Is Different From (and Often Preferable To) Time-Based CCM

CMS explicitly describes APCM as combining elements of CCM/PCM/TCM and communication-technology services into a single monthly bundle—no minute thresholds. You still keep (and can use) CCM codes where appropriate; APCM simply provides a broader, simpler monthly pathway to fund whole-patient primary care.[1]

“Evidence Pack” You’ll Want On File (audit-ready)

  • Consent note with script, staff/date/time.
  • Initiating visit note (if applicable).
  • Care plan (current + version history; copy provided to patient).
  • 24/7 policy (on-call rota, chart access method) + a few after-hours encounter examples.
  • Transitions: ADT alert/workqueue, ≤7-day follow-up timestamp, information exchange note.
  • Gap list & risk tiers export (monthly).
  • Quality/MVP or ACO reporting snapshot (how you’re capturing BP/A1c/screenings).[1]

Financials (Corrected)

  • HCPCS: G0556, G0557, G0558.[1]
  • Payment: varies by MAC/locality. Use the PFS Look-Up Tool to view current allowed amounts and compute patient coinsurance.[3]
  • Mechanics: Payments derive from RVUs × conversion factor, adjusted for geography per standard PFS rules.[4]

Frequently Asked Questions

No. CMS created APCM to bundle and simplify advanced primary care; CCM codes remain available. APCM is billed once per calendar month when its requirements are met.[1]

APCM is a monthly bundle. CMS does not list APCM as time-based and directs you to select one APCM code per month per patient. For other services, follow PFS/NCCI edits and your MAC’s guidance to avoid duplicative billing of overlapping care-management bundles. Use the PFS Look-Up Tool and NCCI resources for policy indicators and code-pair edits.[3]

CMS ties APCM performance measurement to use of certified EHR technology (CEHRT) through the MVP/ACO pathways, so plan to capture structured data and report accordingly.[1]

Clinical staff and auxiliary personnel may furnish services incident to under general supervision; the billing practitioner directs care and remains the patient’s focal point.[1]

Ensure after-hours urgent access to a care-team member who has real-time chart access; allow patients to book successive routine visits with the same team member; support alternative hours/home visits where appropriate. Document your on-call policy and examples.[1]

A living plan that’s accessible inside and outside the practice, routinely updated, and shared with the patient/caregiver (portal or copy).[1]

APCM is a Part B service; coinsurance may apply. Your consent must disclose that.[1]

Use the official PFS Look-Up Tool (G0556–G0558) and select your MAC/locality to view current allowed amounts and compute coinsurance.[3]

How FairPath Helps (short and concrete)

  • Panel identification: Flag candidates and the appropriate APCM level per month.
  • “Evidence-by-design” workflows: Consent, initiating-visit checks, care-plan versioning, on-call log capture, transitions follow-up timers, and gap/risk dashboards aligned to CMS elements.
  • One-click monthly file: Generate clean claims (G0556/57/58) and export quality data for MVP/ACO.

Notes on removed/changed content

  • Replaced G0011/G0511 and “$8–$15 PPM” with APCM HCPCS G0556–G0558 and a PFS look-up instruction (rates are locality-specific).[1]
  • Softened “APCM replaces CCM” messaging to “APCM combines elements and simplifies” (CCM remains available).[1]
  • Removed definitive stacking claims; directed readers to PFS/NCCI policy indicators and MAC guidance to avoid duplication.[7]