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Advanced Primary Care Management: What It Is and Frequently Asked Questions

As of 2025, CMS will reimburse practices for offering their new program, Advanced Primary Care Management. Advanced Primary Care Management is a preventative care program for Medicare patients, offered by providers who serve as the patients’ focal point of care. 

The program combines features from multiple existing care management and telehealth programs, including: 

• Chronic Care Management
• Transitional Care Management
• Principal Care Management
• Interprofessional Internet Consultation
• Remote Evaluation of Patient Videos/Images
• Virtual Check-In
• Online Digital E/M (e-Visit) 

Since CMS officially announced APCM in the 2025 Physician Fee Schedule Final Rule,  ChartSpan has received hundreds of questions about the program. Here are the APCM questions practices ask most frequently. 

Advanced Primary Care Management Services

Who is eligible for APCM? 

Providers can offer APCM to Medicare patients they provide primary care for. There are three levels of APCM:

Level 1: for patients with one or fewer chronic conditions
Level 2: for patients with two or more chronic conditions

Level 3: for patients with two or more chronic conditions who are also Qualified Medicare Beneficiaries

You can see more details on each level in our guide to Advanced Primary Care Management.

What does APCM include? 

APCM must include multiple service elements:

1. Consent: Ask patients if they would like to enroll and record their consent
   
2. Initiating visit: Required for patients who haven’t seen their provider within the past three years
   
3. 24/7/365 access to care: phone or text line for health questions

4. Ability to schedule successive appointments with the same care team

5. Care in alternative ways, such as home visits or expanded hours
   
6. Comprehensive care management: systematic assessment of medical and psychosocial needs, systems to provide preventative care, and medication reconciliation
   
7. Patient-centered care plan: Available electronically and created in collaboration in patients
   
8. Management of care transitions: Oversee transitions from the hospital, ER, or a skilled nursing facility to home and follow up with patients within seven days
   
9. Community-based care coordination: Form relationships with other practitioners, home-and community-based services to assist patients
   
10. Enhanced communication: Provide multiple patient communication methods, including secure messaging, email, online patient portal, and phone
    
11. Population-level management: Ability to stratify patients into three levels of APCM and identify appropriate, targeted interventions
    
12. Performance measurement: Will be evaluated based on quality measures. MIPS-eligible providers must join the Value in Primary Care MVP. 

For more on each of these features, you can view our breakdown of the 2025 Medicare Physician Fee Schedule Final Rule. 

How is APCM different from other care management programs? 

APCM combines features from Chronic Care Management, Transitional Care Management, and Principal Care Management with features like virtual check-in and electronic visits. It differs from other forms of care management because it needs to be offered by a provider who is the patient’s focal point of care, stratifies patients into levels based on need, and relies on quality measures to determine program success. Rather than focusing on specific time thresholds (ex. 20 minutes for CCM), APCM emphasizes making service capabilities available to patients when they need them. 

Do providers have to perform APCM themselves? 

No. APCM can be performed under general supervision, which allows care managers to perform APCM services with oversight from providers. 

Billing for Advanced Primary Care Management

What are the codes for APCM? 

APCM has three codes.

G0556: APCM for Medicare patients with one or fewer chronic conditions
G0557: APCM for Medicare patients with two or more chronic conditions
G0558: APCM for Medicare patients with two or more chronic conditions, who are Qualified Medicare Beneficiaries

If you wish to perform stratification yourself, your practice will need advanced reporting and documentation capabilities. You can also partner with an experienced care management provider, who can help you stratify patients into appropriate levels. 

What is the reimbursement for APCM? 

Reimbursement varies by level. The national averages are:

G0556: $15 per patient, per month
G0557: $50 per patient, per month

G0558: $110 per patient, per month

Can I bill APCM every month, or can it only be billed during a month when care coordination occurs?

After a patient enrolls in the program, you can bill APCM every month. APCM has no monthly time thresholds—providers and care managers are expected to adjust the amount of care provided based on the patient’s needs. All service elements must be available monthly, whether the patient utilizes them or not. 

How many times per year can APCM be billed?

APCM can be billed once per calendar month after the patient enrolls in the program. 

Will patients have a coinsurance responsibility for APCM?? 

Medicare Part B and C will reimburse for APCM. Patients may have coinsurance payments, and deductibles apply. However, coinsurance amounts will vary by patient level. Patients with QMB status will not have an expected coinsurance. 

Dual-Eligibility and Qualified Medicare Beneficiaries

Is APCM only for dually-eligible beneficiaries? 

No. For Level 3 of APCM, patients must be Qualified Medicare Beneficiaries, a specific type of dual-eligible beneficiary. However, Level 1 and 2 APCM patients don’t have to be dual-eligible. They can be enrolled in Medicare only. 

How do you know if a Medicare patient is a Qualified Medicare Beneficiary? 

Practice staff can determine who is a Qualified Medicare Beneficiary using the HIPAA Eligibility Transaction Systems (HETS) database. 

MIPS and Quality

Do you have to join MIPS or MIPS Value Pathways to offer APCM? 

If you are a MIPS-eligible clinician, you will have to join the Value in Primary Care MIPS Value Pathway to offer APCM. If you aren’t MIPS-eligible, you are exempt from this requirement. Whether you are doing MVPs or an Alternative Payment Model, you will need detailed reporting and documentation to ensure you are reimbursed by Medicare. 

Other Care Management Programs

Can APCM, CCM, PCM or TCM be billed together in a month?

APCM, CCM, TCM and PCM cannot be billed for the same patient in the same month. APCM contains many elements that overlap with Chronic Care Management, Transitional Care Management and Primary Care Management. 

Can we bill some of our patients as APCM and others as CCM, PCM, or TCM? 

Yes. However, running multiple different care programs at the same time will add complexities and workload.

Are Chronic Care Management, Principal Care Management, or Transitional Care Management going away when APCM launches? 

No. You can continue to offer CCM, PCM, and TCM as well as APCM. You just can’t enroll one patient in all of the programs at the same time. 

Advanced Primary Care Management Services for All Practices

Advanced Primary Care Management could improve outcomes for Medicare patients, helping them avoid unnecessary hospitalizations and ER visits and enhance their quality of life. However, the program requires advanced stratification and quality reporting abilities, as well as in-depth, personalized care management.

ChartSpan has been building the infrastructure to accurately document patient data, determine eligibility, support and document patient care, and report on quality for more than 10 years. If you’d like to learn more about the capabilities we’ve put in place to offer effective, compliant APCM, you can view our guide to APCM here.