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What Is APCM? Advanced Primary Care Management Explained

Three monthly codes set by the patient, not the minutes: who bills, which level, and what Medicare pays in 2026.

Updated October 2026 · Checked against the CMS sources below

Short answer: APCM stands for advanced primary care management: a monthly Medicare Part B service billed by the practitioner responsible for all of a patient’s primary care. It uses G0556, G0557 or G0558, based on chronic conditions and Qualified Medicare Beneficiary status, without counting minutes. The practice must meet the service requirements for each month billed.

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APCM is the monthly code set CMS created in the CY2025 Physician Fee Schedule final rule for a patient’s primary care practitioner. Since January 1, 2025, that practitioner can bill one APCM code per patient per calendar month.

CMS describes APCM as combining elements of care management services practices may already bill one by one, chronic care management (CCM), principal care management (PCM) and transitional care management (TCM) among them.

TL;DR: APCM in five lines

What it is: one Medicare code per patient per month, with no minutes to count.

Who bills: the practitioner responsible for all of the patient’s primary care.

Which level: set by chronic conditions and Qualified Medicare Beneficiary status.

What the patient does: consents once; cost sharing may apply.

The same-month rule: the APCM practitioner cannot also bill CCM, PCM or TCM for that patient that month.

Clinician reviewing care management billing data: APCM codes G0556, G0557, G0558

APCM codes G0556, G0557 and G0558: which level fits which patient

All three levels require the same service elements.

Code	Level	Chronic conditions	Qualified Medicare Beneficiary
G0556	Level 1	Zero or one meeting the Level 2 test	Not required
G0557	Level 2	Two or more, expected to last at least 12 months or until death, placing the patient at significant risk of death, acute exacerbation or decompensation, or functional decline	Not required
G0558	Level 3	Two or more, meeting the Level 2 test	Required

APCM codes G0556 to G0558: what sets the level.

A Qualified Medicare Beneficiary is a patient for whom Medicaid is responsible for the Medicare deductible and coinsurance. CMS’s FAQ adds that any patient who consents is eligible, so Level 1 reaches patients that CCM and PCM, the time-based alternatives, do not.

Who can bill APCM

A physician, nurse practitioner, physician assistant or clinical nurse specialist can bill APCM when all three conditions are met:

They are responsible for all of the patient’s primary care.
They serve as the focal point for every health care service the patient needs.
They have documented the patient’s written or verbal consent.

APCM requirements, month by month

The billing practice gets written or verbal consent before APCM starts and documents it in the medical record. The patient must hear that only one practitioner can furnish and be paid for APCM in a calendar month, that they can stop at any time, and that cost sharing may apply.

The initiating visit, and when it is not needed

Exemption: no initiating visit is required if the billing practitioner or another practitioner in the practice saw the patient within 3 years or furnished APCM, CCM or PCM within a year.
Source difference: CMS’s FAQ names the billing practitioner alone for the 3-year test. Confirm with your MAC whether a colleague’s visit counts.
Qualifying visits: E/M levels 2 to 5 (99212 to 99215), the TCM face-to-face visit, an annual wellness visit or an initial preventive physical examination, with APCM discussed.
Annual wellness visit: the practitioner responsible for APCM must perform it.

If no exemption applies, complete an initiating visit before APCM starts; bill it separately.

Every month: the service elements, as the patient needs them

A practice billing APCM must be able to furnish every element below for any patient in any month it bills, and furnishes each one as medically reasonable and necessary. CMS’s own example: a Level 2 patient with heart failure and chronic kidney disease sends a photo of swollen legs, and the practitioner must be able to interpret it remotely.

Access and continuity: urgent access 24 hours a day, 7 days a week to a team member with real-time record access; routine appointments with a designated team member; care beyond office visits, such as expanded hours.
Comprehensive care management: needs assessment, preventive services and medication reconciliation.
Electronic care plan: the team can access and update it; the patient or caregiver receives a copy.
Care transitions: referrals, electronic information exchange and follow-up within 7 days of facility discharge, as clinically indicated.
Care coordination: ongoing, documented communication with practitioners and home- and community-based providers about psychosocial strengths, functional deficits, goals and preferences.
Enhanced communication: secure messaging or a portal, remote evaluation of recorded information, interprofessional consultation, virtual check-ins and e-visits.
Population management: identify gaps in care and risk-stratify patients.
Performance reporting: the Value in Primary Care MIPS Value Pathway, or participation in a Shared Savings Program ACO or REACH ACO.

What the record has to show

Consent goes in the chart, as does any element used to furnish APCM to a specific patient; CMS does not expect an APCM program’s practice-level capabilities in every chart. By billing APCM, the practitioner attests that the code descriptor’s requirements were met.

An older man in a white shirt and a woman in a blue blazer talking across a conference table with an open binder and two tablets — The care plan goes to the patient or caregiver.

APCM staffing and supervision rules

Under the CY2026 rules, APCM is a designated care management service, so auxiliary personnel can furnish it incident to the services of the practitioner who bills it, under general supervision. Under 42 CFR 410.26 they can be employees, leased employees or independent contractors; they cannot be excluded by the HHS Office of Inspector General or have had their Medicare enrollment revoked, and they must meet any licensure or other requirements of the state in which the services are furnished.

APCM billing rules: what else can be billed the same month

Other service	Same APCM practitioner	Different practitioner
CCM, PCM and TCM	Cannot bill	May bill when medically necessary, including in the same practice
Interprofessional consultation, remote image evaluation, virtual check-ins and e-visits	Cannot bill	May bill when medically necessary, including in the same practice
BHI, CHI, PIN including peer support, RPM and RTM	May bill; do not count PIN or CHI time and effort twice	May bill; do not count PIN or CHI time and effort twice

Same-patient, same-month billing alongside APCM: CMS rules, not a service list.

From January 1, 2026, the APCM practitioner can also bill behavioral health add-ons without counting minutes: G0568 for the initial collaborative care month, G0569 for later months, and G0570 for general BHI. Each requires an APCM base code billed by the same practitioner in the same month (CY2026 final rule).

A smiling physician in a white coat over blue scrubs, stethoscope around his neck, against a teal background, standing for the billing practitioner who supervises APCM staff — Auxiliary personnel work under the billing practitioner’s general supervision.

Common APCM billing mistakes

Three ways practices misread APCM

“Every element has to be delivered every month.” CMS requires the ability to furnish every element in any month the practice bills, not delivery of all of them every month.

“Any Medicaid patient is Level 3.” G0558 requires Qualified Medicare Beneficiary status, not just Medicaid coverage.

“Any practitioner can bill the behavioral health add-ons.” G0568, G0569 and G0570 are billed only with an APCM base code, by the same practitioner, in the same month.

Companian support for APCM

Companian supports advanced primary care management (APCM) for partner practices; the practice bills G0556, G0557 and G0558 under its own NPI.

Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Key takeaways

Level 1 (G0556) covers patients with zero or one qualifying chronic condition; Level 3 (G0558) requires Qualified Medicare Beneficiary status.
Auxiliary personnel, including independent contractors, can furnish APCM under the billing practitioner’s general supervision.
Consent is documented once; an initiating visit is needed unless the billing practitioner has seen the patient within 3 years or furnished APCM, CCM or PCM within the past year (confirm with your MAC whether a colleague’s visit counts).
The practice must be able to furnish every service element in any month it bills.
Behavioral health integration, PIN, CHI, RPM and RTM can still be billed in the same month as APCM.

Questions about the APCM codes

What does APCM mean in Medicare?

APCM stands for advanced primary care management. In Medicare it is a Part B Physician Fee Schedule service, billable since January 1, 2025 with HCPCS G0556, G0557 and G0558.

Do Making Care Primary or Primary Care First still meet the APCM reporting requirement?

No. Both are still listed on CMS’s APCM page, but Making Care Primary ended early on June 30, 2025, and Primary Care First’s final performance period ended on December 31, 2025.

Can a specialist bill APCM?

Only one who is responsible for all of the patient’s primary care. CMS describes the codes as primarily for primary care specialties such as family medicine, general internal medicine, geriatric medicine and pediatrics.

Can FQHCs and RHCs bill APCM?

Yes. CMS’s APCM FAQ says FQHCs and RHCs can bill APCM with or without a qualifying visit, paid at the Physician Fee Schedule non-facility rate.

Do patients pay anything for APCM?

Cost sharing may apply, and the consent conversation has to say so. For 2026, the Part B deductible is $283 and Part B coinsurance is 20 percent. For a Qualified Medicare Beneficiary, including every Level 3 patient, Medicaid is responsible for the deductible and coinsurance.

What place of service goes on an APCM claim?

The location where the billing practitioner would ordinarily see the patient face to face. CMS prices APCM in both facility and non-facility settings.

APCM is a monthly Medicare Part B service billed with G0556, G0557 or G0558. The practitioner responsible for all of a patient’s primary care bills it and cannot also bill CCM or PCM for that patient in the same month. Companian supports advanced primary care management (APCM) for partner practices; the practice bills G0556, G0557 and G0558 under its own NPI.

Sources

Federal Register, CY 2025 Physician Fee Schedule final rule (89 FR 97710), December 9, 2024
Federal Register, CY 2026 Physician Fee Schedule final rule (90 FR 49266), November 5, 2025
CMS, Advanced Primary Care Management Services
CMS, Advanced Primary Care Management (APCM) Services FAQ
CMS Innovation Center, Making Care Primary (MCP) Model
CMS Innovation Center, Primary Care First Model Options
eCFR, 42 CFR 410.26
CMS, MM14279, CY 2026 Part B deductible and coinsurance
CMS, Frequently Asked Questions about Billing the Physician Fee Schedule for Chronic Care Management Services

About the author

Companian Editorial Team

The Companian Editorial Team writes plain-language guides to Medicare care management rules for physician practices, their administrators and their billing teams. Each guide is built from CMS publications, the Medicare Physician Fee Schedule rules in the Federal Register and the eCFR, which are listed in its sources.

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