What Is APCM?
Effective for CY2025, CMS finalized coding and payment for APCM services under the Physician Fee Schedule — three new HCPCS codes (G0556, G0557, G0558) that combine elements of principal care management, transitional care management, chronic care management, interprofessional consultations, and communication technology-based services (like virtual check-ins and e-visits) into one monthly payment.
Why APCM Was Introduced
CMS designed APCM to simplify billing and documentation for practices already coordinating care across several separate time-based codes. Rather than requiring a practice to track and report minutes separately for each care-management activity, APCM consolidates the relevant activities into one monthly payment tied to the patient's condition tier — reflecting that patient needs and the mix of qualifying activities can vary from month to month.
How APCM Works
Rather than tracking and documenting minutes each month, a practice bills one of three flat monthly codes based on the patient's chronic-condition profile. This is intended to simplify billing and documentation while reflecting that patient needs vary month to month.
Who APCM Is Designed For
APCM is intended for physicians and non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists) who serve as a patient's continuing, comprehensive primary care focal point — typically general internal medicine, family medicine, geriatric medicine, or pediatrics.
APCM Billing Structure
Three tiers apply: G0556 for patients with 0 or 1 chronic condition, G0557 for patients with 2 or more chronic conditions, and G0558 for patients with 2 or more chronic conditions who are also Qualified Medicare Beneficiaries. Each is billed once per calendar month, and only one provider can furnish and be paid for APCM services for a given patient during that month.
APCM vs CCM
See our detailed APCM vs CCM comparison — in short, CCM is time-based and requires monthly minute tracking, while APCM is a flat monthly payment based on the patient's condition tier.
APCM vs PCM
Principal Care Management (PCM, CPT 99424-99427) targets a single high-risk chronic condition expected to last at least 3 months, billed by time thresholds much like CCM. APCM differs in both scope and structure: it bundles activity across a patient's overall primary care relationship (not one specific condition) into a single flat monthly payment tied to a chronic-condition tier, rather than a per-condition, time-based code.
Care Coordination Requirements
APCM requires timely exchange of electronic health information with other treating practitioners, and follow-up (direct contact, phone, or electronic) with the patient or caregiver within 7 days of a hospital, ED, or skilled nursing facility discharge.
Patient Communication
Practices must offer 24/7 access for urgent needs, real-time access to the patient's medical information, the ability to schedule successive routine appointments with a designated care team member, and asynchronous, non-face-to-face communication options beyond phone calls — such as secure messaging, email, or a patient portal.
Risk Stratification
The tier structure itself is a form of risk stratification: chronic-condition count (and QMB status for the top tier) determines the applicable code and payment level.
Quality Measurement
CMS's published APCM materials reviewed for this page describe the service, billing, and access requirements above; consult current CMS guidance for any quality-reporting program interactions that may apply to your practice.
Technology Requirements
An electronic, patient-centered comprehensive care plan — accessible within and outside the billing practice — is required, along with the asynchronous communication and remote information-review capabilities described above.
Implementation Considerations
See our APCM Billing Requirements guide for a practical implementation checklist covering consent, care-plan infrastructure, access requirements, and documentation.