What it is

Advanced Primary Care Management (APCM) is a bundled monthly service, created in the CY2025 Medicare Physician Fee Schedule, that folds together elements of Chronic Care Management, Principal Care Management, and Transitional Care Management into a single set of three tiered codes.

Unlike CCM or PCM, APCM has no clinical-staff time threshold to track each month. Instead, the practitioner bills one of three flat-rate codes based on how many chronic conditions the patient has and whether the patient is a Qualified Medicare Beneficiary (QMB).

Who qualifies

• Patient is enrolled in Medicare Part B and the billing practitioner is the continuing, comprehensive focal point for that patient's primary care
• Level 1 (G0556): patient has zero or one chronic condition expected to last at least 12 months or until death (the baseline tier, not limited to exactly one condition)
• Level 2 (G0557): patient has two or more such chronic conditions
• Level 3 (G0558): patient has two or more chronic conditions and is enrolled as a Qualified Medicare Beneficiary (QMB) specifically, being enrolled in a different Medicare Savings Program category (such as SLMB or QI) does not qualify
• Patient has given documented consent (verbal consent is acceptable) to receive APCM services and understands any applicable cost-sharing

Codes at a glance

What's required to bill

• Documented patient consent for APCM services
• An initiating visit for new patients, or those not seen by the practice within the past three years, unless the patient already received another type of care management (like CCM) from the practice within the past year
• 24/7 access to the care team for urgent needs, including access to the patient's own care record
• Continuity of care with a designated care team member or practitioner
• Comprehensive care management across the patient's medical, functional, and psychosocial needs
• A patient-centered, comprehensive care plan that is created, maintained, and shared with the patient
• Active management of care transitions between providers and care settings
• Coordination with home- and community-based providers
• Enhanced, non-face-to-face communication options such as secure messaging or a patient portal
• Population-level management of the practice's empaneled patients using data
• Performance measurement, satisfied for MIPS-eligible clinicians by reporting the Value in Primary Care MVP
• Patients can stop receiving APCM services at any time by telling their provider

Documentation checklist

• Signed or verbally-documented APCM consent in the chart
• Evidence of an initiating visit where one is required
• A written, patient-specific care plan accessible to the whole care team
• Documentation supporting the chronic-condition count, and for G0558 the QMB status, used to select the billing tier
• A record of care coordination activity during the month (referrals, transitions, home/community-based provider contact)
• Confirmation that only one APCM tier was billed for the patient in the calendar month, and that it was not billed alongside a conflicting care-management code for the same period

Common billing mistakes

• ✕Billing more than one APCM tier for the same patient in the same month
• ✕Selecting G0558 without documented QMB status specifically (being enrolled in a different Medicare Savings Program category, such as SLMB or QI, does not qualify)
• ✕Billing APCM and CCM, PCM, or TCM concurrently for the same patient and period when their service elements overlap
• ✕Treating APCM as purely time-based and under-delivering on the non-time elements (24/7 access, care plan, transitions) because staff time was logged
• ✕No initiating visit on file for a new patient
• ✕Missing or undocumented patient consent

FAQ