Advanced primary care management (APCM) is Medicare’s newest care management framework, effective January 1, 2025. It replaces the time thresholds that define CCM with a flat monthly payment set by patient complexity: G0556 pays $16.37 for patients with one or fewer chronic conditions, G0557 pays $53.78 for patients with two or more, and G0558 pays $117.24 for patients with two or more who are also Qualified Medicare Beneficiaries. All figures are 2026 national non facility amounts before geographic adjustment.
The three levels
- G0556, level 1: zero or one chronic condition. $16.37 per month.
- G0557, level 2: two or more chronic conditions 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 (the same clinical test CCM uses). $53.78 per month.
- G0558, level 3: the same two plus condition criteria as level 2, and the patient is a Qualified Medicare Beneficiary. QMB is a dual eligibility status, not a clinical finding, so this level is identified from coverage data. $117.24 per month.
No time tracking, but real capability requirements
APCM has no minute thresholds. What it has instead is a required set of service capabilities, grouped by CMS into ten categories: consent, an initiating visit for patients new to the practice, 24/7 access and continuity of care, comprehensive care management, a patient centered comprehensive care plan, management of care transitions, coordination across practitioners and home and community services, enhanced communication (including secure electronic options), population level management, and performance measurement. You may see other summaries count 13 service elements. That is the same list, counted the way the code descriptor in the final rule breaks it out. CMS’s APCM page groups the same requirements into these ten.
The practice must be able to furnish every element, and furnish each one when clinically appropriate for the individual patient that month. Not every element must be performed and documented every month. That capability standard is the real implementation work: it is a practice infrastructure test, not a stopwatch test.
Who bills it, and the consent and visit rules
APCM is billed by the physician or non physician practitioner who is responsible for the patient’s primary care and serves as the continuing focal point for their health care needs. CMS expects these codes to be used mostly by primary care specialties, but it does not limit APCM by specialty, and the final rule points to OB/GYN and cardiology as examples of specialists who sometimes fill that role. The monthly work can be done by auxiliary personnel incident to the billing practitioner under general supervision. Consent, written or verbal, must be documented once before billing starts and must cover cost sharing, the one practitioner per month rule, and the right to stop. New patients need an initiating visit unless the practice has seen them within the past three years or furnished them another care management service within the past year.
What can and cannot run alongside APCM
This is where most summaries get it wrong. The final rule’s restriction is practitioner level, not practice level: the practitioner billing APCM cannot also bill CCM, PCM, TCM, interprofessional consultations, remote image evaluation, virtual check ins, or e visits for that patient in the same month, but another practitioner may, when it is medically necessary. And Medicare explicitly allows behavioral health integration, community health integration, principal illness navigation, SDOH risk assessment, and remote monitoring to run concurrently with APCM. Notably, both RPM and RTM may run alongside APCM at the same time, a combination the CCM rules do not allow. For 2026, CMS also added dedicated behavioral health add on codes (G0568 and G0569 for the collaborative care model, G0570 for general BHI) that are billed specifically on top of the APCM base codes.
CCM or APCM?
For a level 2 patient, APCM pays $53.78 flat while CCM pays $66.13 and up when your staff reliably logs 20 plus minutes. High touch panels with disciplined time tracking often earn more under CCM; practices whose staff time is real but hard to capture, or whose QMB share is high, often do better under APCM. The right answer is arithmetic on your own panel, payer mix, and staffing, and it can differ patient by patient since the codes are chosen per patient.
Practice Management Consultancy runs exactly that analysis and builds the program your numbers support, staffed by your own team. Start with a care management assessment, or read the CPT 99490 requirements for the CCM side of the comparison.
Sources
- CMS, Advanced Primary Care Management Services (page updated January 2026)
- CY 2025 Physician Fee Schedule final rule, 89 FR 97710 (APCM discussion at 97859 through 97897)
- CMS Physician Fee Schedule Relative Value File, July 2026 release (rates shown are 2026 national non facility amounts, standard conversion factor, before locality adjustment)
