Advanced Primary Care Management (APCM) Billing Overview

Overview

Advanced Primary Care Management (APCM) is a new set of CMS billing codes introduced in the 2025 Medicare Physician Fee Schedule to support primary care practices transitioning to value-based care. APCM codes (G0556, G0557, G0558) incentivize comprehensive, patient-centered care for patients with chronic conditions, emphasizing care coordination, digital health integration, and reduced administrative burden. These codes align with CMS’s goal of enrolling all Medicare beneficiaries in accountable care models by 2030.

What are the 2025 APCM CPT Codes?

APCM services are billed monthly under three HCPCS codes, each tailored to specific patient needs:

• G0556 (Level 1)

  • Description: APCM services for patients with one chronic condition, provided by clinical staff under a physician or qualified healthcare professional responsible for all primary care, per calendar month.

  • Reimbursement: ~$15 per month

  • Note: CMS increased the valuation from $10 to $15 based on stakeholder feedback, reflecting resource needs.

• G0557 (Level 2)

  • Description: APCM services for patients with two or more chronic conditions expected to last at least 12 months or until death, posing significant risk of death, exacerbation, or functional decline, provided by clinical staff under a physician or qualified healthcare professional, per calendar month.

  • Reimbursement: ~$50 per month

  • Note: Targets complex chronic condition management.

• G0558 (Level 3)

  • Description: APCM services for Qualified Medicare Beneficiaries (QMB) with two or more chronic conditions expected to last at least 12 months or until death, posing significant risk of death, exacerbation, or functional decline, provided by clinical staff under a physician or qualified healthcare professional, per calendar month.

  • Reimbursement: ~$110 per month

  • Note: Designed for high-risk QMB patients.

What are the APCM Requirements in 2025?

APCM codes require practices to be capable of delivering 13 service elements, though not all are required monthly, allowing flexibility based on patient needs. Key requirements include:

• Obtain patient consent for APCM services.

• Conduct an initiating visit for patients not seen within 3 years.

• Provide 24/7 access to the care team for urgent needs.

• Designate a contact for continuity of care.

• Offer alternative care delivery options (e.g., virtual visits).

• Perform comprehensive care management, including assessments, preventive services, and medication management.

• Maintain an electronic care plan accessible to patients and providers.

• Coordinate care transitions and community-based services.

• Utilize asynchronous, non-face-to-face digital communications.

• Conduct patient population analysis and risk stratification.

• Use Certified Electronic Health Record Technology (CEHRT) for performance measurement.

Billing Notes:

• APCM cannot be billed concurrently with Chronic Care Management (CCM), Principal Care Management (PCM), or Transitional Care Management (TCM).

• Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) are separately billable.

• Unlike CCM/PCM, APCM does not require tracking minutes, reducing administrative burden.

HealthSnap + APCM

HealthSnap’s integrated care management platform streamlines APCM implementation by automating workflows, ensuring compliance with CMS requirements, and enhancing patient engagement through digital health tools. Our platform supports:

• Real-time patient data integration for risk stratification and care planning.

• Secure, asynchronous communication for patient-provider interactions.

• Comprehensive reporting to meet CEHRT and performance measurement needs.

• Scalable solutions to manage chronic conditions across diverse patient populations.

Ready to implement APCM? Contact HealthSnap to learn how our platform can optimize your practice’s transition to value-based care and maximize reimbursement opportunities.

Disclaimer: Billing and coding guidelines are subject to change. Consult a qualified healthcare attorney or compliance specialist to ensure CMS compliance.