Advanced Primary Care Management Services

Advanced Primary Care Management (APCM) services combine elements of several existing care management and communication technology-based services you may have already been billing for your Medicare patients. This payment bundle reflects the essential elements of advanced primary care, including:

• Principal care management (PCM)
• Transitional care management (TCM)
• Chronic care management (CCM)

Communication technology-based services include:

• Virtual check-ins
• Remote evaluations of pre-recorded patient information
• Interprofessional consultations

APCM services allow you to simplify your billing and documentation requirements while ensuring your patients have access to high-quality primary care services by:

• Providing patients with a wide range of services to meet their individual needs based on complexity
• Billing for these services using a monthly bundle instead of billing for each service or recording by the minute

Starting January 1, 2025, you can bill for APCM services if:

• You’re a physician or non-physician practitioner, including a nurse practitioner, physician assistant, certified nurse midwife, or clinical nurse specialist
• You’re responsible for all your patient’s primary care services
• You’re the focal point for all your patient’s needed health care services
• You got either written or verbal consent from your patients

Primary care specialties, such as general internal medicine, family medicine, geriatric medicine, or pediatrics, are most likely to regularly use APCM service codes.

You can bill for APCM services once per patient per calendar month. This helps remove some of the burden of billing with individual, time-based care management codes. 

Individual care management services are time-based codes, which require you to meet certain thresholds and document every minute spent doing care management activities. APCM services aren’t time based, and you can bill using an APCM HCPCS code once per month when you meet the billing requirements.

The resources required to provide effective advanced primary care vary based on patient complexity, so choose the HCPCS code for APCM services that’s most appropriate for your patient’s medical complexity.

Use 1 of these 3 codes:

Effective January 1, 2026, we added 3 new optional add-on HCPCS codes when you provide general behavioral health integration (BHI) and psychiatric collaborative care model (CoCM) services in the same month as APCM services. 
BHI services help you manage care for your patient's behavioral health condition, such as:

• Depression
• Anxiety
• Another mental health condition

Under Part B, a 20% patient copayment applies for BHI services.

Can I Bill the BHI Add-On HCPCS Codes at the Same Time?

You must meet all the requirements and bill an APCM HCPCS base code (G0556, G0557, or G0558) in the same month as the optional add-on codes. These new HCPCS codes aren’t time based.
 

To bill for APCM services, you must complete these elements when they’re clinically appropriate for the individual patient. Note: You don’t have to provide all of these services every month:

• Get patient consent. Get written or verbal consent from the patient to participate in APCM services before starting and document the consent in the patient’s medical record. You need to get consent from the patient only once, and the consent must inform your patient that:
  • Only 1 provider can render and get payment for APCM services during a calendar month
  • The patient has the right to stop services at any time
  • Under Part B, a 20% patient copayment generally applies

• Conduct an initiating visit (paid separately) for new patients. You don’t need to conduct this visit if you or another provider in your practice has:

  • Had a visit with the patient within the past 3 years
  • Provided another care management service, such as APCM, CCM, or PCM, to the patient within the past year

  The Medicare Annual Wellness Visit (AWV) may qualify as the initiating visit if the provider responsible for providing APCM care performs the AWV.

• Provide 24/7 access and continuity of care, including:
  • 24/7 access for your patients or their caregivers with urgent needs to contact you or another care team member
  • The ability for the patient to schedule successive routine appointments with a designated care team member
  • Alternatives to traditional office visits, such as home visits or expanded hours
• Provide comprehensive care management, including:
  • Needs assessments (medical and psychosocial)
  • System-based approaches to ensure your patient gets preventive services
  • Medication reconciliation, management, and oversight of self-management
• Develop, implement, revise, and maintain an electronic patient-centered comprehensive care plan.
  • You must make the care plan available within and outside the billing practice, as appropriate, to individuals involved in the patient’s care
  • Care team members must be able to access and update the care plan routinely
  • You must also give a copy of the care plan to the patient or their caregiver

• Coordinate care transitions between and among health care providers and settings, including:

  • Referrals to other providers
  • A follow-up after an Emergency Department (ED) visit
  • Follow-up after discharge from a hospital, skilled nursing facility (SNF), or other health care facility 

  Coordination of care transitions must include: 

  • Exchanging electronic health information in a timely manner with other health care providers
  • Following up (using direct contact, phone, or electronic communication) with the patient or their caregiver within 7 days of discharge from an ED visit or from a hospital, a SNF, or another health care facility, as clinically indicated

• Coordinate practitioner, home, and community-based care. You must provide ongoing coordinating communication to coordinate care with everyone involved in the patient’s care. Document the patient’s:

  • Psychosocial strengths
  • Functional deficits
  •  Goals
  • Preferences
  • Desired outcomes

  Share updates with:

  • Practitioners
  • Home- and community-based service providers
  • Community-based social service providers
  • Hospitals
  • SNFs
  • Other members of the care team
• Provide enhanced communication opportunities. You must be able to: 
  • Offer asynchronous, non-face-to-face consultation methods other than the phone, such as through secure messaging, email, internet, or a patient portal
  • Conduct remote evaluation of pre-recorded patient information and provide interprofessional phone, internet, or electronic health record (EHR) referral services
  •  Use patient-initiated digital communications that require a clinical decision, such as through virtual check-ins, digital online assessment and management, and evaluation and management visits (or e-visits)
• Conduct patient population-level management. You must:
  • Analyze patient population data to identify care gaps
  • Use defined diagnoses, claims, or other electronic data to group your patient population by risk to identify which patients need specific services
• Measure and report performance. This includes assessing primary care quality, total care cost, and meaningful use of certified EHR technology. You can either:
  • Report the value in the Primary Care Merit-based Incentive Payment System (MIPS) Value Pathway; you'll report performance starting in 2026 for CY 2025
  • Participate in a Medicare Shared Savings Program Accountable Care Organization (ACO); ACO Realizing Equity, Access, and Community Health (REACH) Model; Making Care Primary Model; or Primary Care First model

Auxiliary personnel can provide APCM services incident to the professional services of the provider who bills the initiating visit (if required) and associated APCM services. APCM is a designated care management service, and auxiliary personnel will work under the provider's general supervision.

Auxiliary personnel are individuals whom physicians or other billing providers supervise to perform services incident to the providers’ professional services. They:

• Can be employees, leased employees, or independent contractors of the billing provider
• Must not be excluded from Medicare, Medicaid, or other federally funded healthcare programs by the Office of the Inspector General or have had their Medicare enrollment revoked
• Must meet any applicable requirements to provide “incident to” services, including licensure, imposed by the state in which they provide the services

• To learn more about APCM services, visit the 
  • CY 2025 Physician Fee Schedule Final Rule
  • CY 2026 Physician Fee Schedule Final Rule
  • Advanced Primary Care Management (APCM) Services FAQ