Part of Advanced Primary Care Management
HCPCS G0557: Advanced Primary Care Management, Level 2
Flat monthly APCM service for a patient with two or more chronic conditions.
Time threshold & code combinations
No minimum time requirement: billed once per calendar month per patient.
- Mutually exclusive with G0556 and G0558 for the same month
- Not billed alongside CCM, PCM, or TCM for the same patient and period
Who can bill
- Physicians
- Nurse practitioners, physician assistants, and other non-physician practitioners serving as the patient's continuing primary care focal point
Eligibility & billing requirements
- Patient has two or more chronic conditions, each expected to last at least 12 months or until death, or that place them at risk of exacerbation, decompensation, or functional decline
- Practitioner is the continuing, comprehensive focal point for the patient's primary care
- Documented patient consent
- All APCM service elements must be in place for the month billed
- Only one APCM tier billed per patient per calendar month
- Not billed concurrently with CCM, PCM, or TCM for the same patient and period
When to use it
Multiple chronic conditions managed together
A patient with diabetes and chronic kidney disease, both actively managed under one care plan, meets the two-condition threshold for Level 2.
Billing: G0557
Escalating from Level 1
A patient previously billed under G0556 develops a second qualifying chronic condition; the practice updates the care plan and moves the patient to Level 2 going forward.
Billing: G0557, starting the month the second condition is documented
Documentation checklist
- Consent on file
- Care plan reflecting both (or all) qualifying chronic conditions
- Chart documentation supporting the condition count used to select this tier
Common billing mistakes
- Billing G0557 without clearly documenting two distinct qualifying chronic conditions
- Failing to re-evaluate the tier when a patient's condition count changes