Updated for 2026. Medicare Advanced Primary Care Management (APCM) uses three primary HCPCS codes: G0556, G0557, and G0558.
Unlike traditional Chronic Care Management codes that depend on documented monthly minutes, APCM uses a monthly bundled payment model. CMS states that APCM services are not time based and may be billed once per patient per calendar month when the applicable requirements are satisfied.
The correct APCM code depends primarily on the patient's medical and social complexity, number of qualifying chronic conditions, and whether the patient has Qualified Medicare Beneficiary status.
G0556, G0557 & G0558 at a Glance
CodeAPCM LevelKey Patient RequirementG0556Base / Level 1 APCMCore APCM requirements; CMS educational materials describe this level for patients with 0 or 1 chronic conditionG0557Level 2 APCM2 or more qualifying chronic conditionsG0558Level 3 APCMQualified Medicare Beneficiary with 2 or more qualifying chronic conditions
What Is Advanced Primary Care Management?
APCM combines elements of several Medicare care-management and communication services into one monthly primary-care bundle.
CMS states that APCM incorporates elements of:
- Chronic Care Management (CCM)
- Principal Care Management (PCM)
- Transitional Care Management (TCM)
- Virtual check-ins
- Remote evaluation of prerecorded patient information
- Interprofessional consultations
The purpose is to support advanced longitudinal primary care without requiring practices to separately bill every included service or track care-management minutes throughout the month.
Is APCM Time Based?
No. This is one of the biggest differences between APCM and traditional CCM.
CMS states that APCM services are not based on a monthly minute threshold. The appropriate APCM HCPCS code can be reported once per patient per calendar month when its billing requirements are satisfied.
Practices still need documentation showing that the required APCM capabilities and clinically appropriate services are being provided.
What Is HCPCS G0556?
G0556 is the foundational APCM code.
CMS's current billing guidance states that clinical staff may provide APCM services while a physician or other qualified healthcare professional:
- Is responsible for all of the patient's primary-care services
- Directs the clinical staff
- Serves as the continuing focal point for all needed healthcare services
CMS Medicare Learning Network materials describe G0556 as Level 1 APCM for patients with zero or one chronic condition.
Most importantly, the practice must satisfy the broader APCM service requirements when clinically appropriate for the individual patient.
What Is HCPCS G0557?
G0557 is used when the patient has two or more qualifying chronic conditions.
CMS requires these conditions to:
- Be expected to last at least 12 months or until the patient's death
- Place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline
G0557 also includes the underlying APCM requirements applicable to G0556.
Example G0557 Patient
A Medicare patient has diabetes, hypertension, COPD, and chronic kidney disease. The primary-care practice serves as the patient's continuing focal point, maintains a comprehensive care plan, coordinates specialists and care transitions, offers required communication capabilities, and performs population-level management.
If the applicable CMS requirements are met, the practice may evaluate G0557.
What Is HCPCS G0558?
G0558 is designed for patients who:
- Have two or more qualifying chronic conditions
- Meet Medicare's applicable duration and clinical-risk requirements
- Have Qualified Medicare Beneficiary (QMB) status
G0558 includes the other APCM service requirements that apply to G0556.
What Is Qualified Medicare Beneficiary Status?
The Qualified Medicare Beneficiary program is a Medicare Savings Program for eligible people with limited income and resources.
QMB status is particularly important for APCM because it distinguishes G0558 from G0557.
A practice should verify QMB status through appropriate Medicare eligibility information rather than assuming eligibility from a patient's financial circumstances.
G0557 vs G0558
RequirementG0557G05582+ chronic conditionsYesYesExpected to last 12 months or until deathYesYesSignificant clinical riskYesYesQualified Medicare BeneficiaryNot required by the codeRequiredCore APCM requirementsYesYes
Who Can Bill APCM?
CMS states that APCM may be billed by eligible physicians and certain non-physician practitioners, including:
- Physicians
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
The billing practitioner must be responsible for the patient's primary-care services and act as the continuing focal point for the patient's needed healthcare services.
CMS notes that APCM is primarily intended for primary-care specialties such as family medicine, general internal medicine, geriatrics, and pediatrics.
Can Clinical Staff Provide APCM Services?
Yes. CMS permits auxiliary personnel to provide APCM services incident to the billing practitioner's professional services under general supervision when applicable requirements are met.
Auxiliary personnel may include employees, leased employees, or independent contractors who meet Medicare and applicable state requirements.
The billing practitioner still retains responsibility for the APCM service and the patient's overall primary care.
1. Patient Consent
Before beginning APCM, the practice must obtain either written or verbal patient consent and document it in the medical record.
CMS states that the patient should be informed that:
- Only one provider can furnish and be paid for APCM services during a calendar month
- The patient may stop the service at any time
- Cost sharing may apply
CMS states that APCM consent generally only needs to be obtained once.
2. Initiating Visit
CMS requires a separately paid initiating visit for new APCM patients in certain circumstances.
An initiating visit is not required if the patient has been seen by the practitioner or another provider in the same practice within the previous three years, or if the practice has provided APCM, CCM, or PCM to the patient within the previous year.
A Medicare Annual Wellness Visit may qualify as the initiating visit when performed by the practitioner responsible for APCM care.
3. 24/7 Access and Continuity
APCM practices must support access and continuity of care.
CMS requirements include capabilities such as:
- 24/7 access for urgent care-management needs
- Real-time access to relevant patient medical information
- Successive routine appointments with a designated care-team member
- Alternative care-delivery options when appropriate
4. Comprehensive Care Management
APCM requires comprehensive management based on the patient's individual needs.
This may include:
- Systematic assessment of medical needs
- Assessment of psychosocial needs
- Preventive-care gap management
- Medication reconciliation
- Medication management
- Support for patient self-management
5. Electronic Comprehensive Care Plan
CMS requires the practice to develop, implement, revise, and maintain an electronic patient-centered comprehensive care plan.
The plan should be available, as appropriate, to individuals involved in the patient's care inside and outside the billing practice.
Care-team members should be able to access and update it, and CMS requires that a copy be provided to the patient or caregiver.
6. Care-Transition Management
APCM includes coordination across healthcare settings.
Examples include:
- Specialist referrals
- Emergency-department follow-up
- Hospital discharge follow-up
- Skilled nursing facility transitions
- Other clinically significant care transitions
CMS also requires timely electronic exchange of health information and, when clinically indicated, follow-up communication with the patient or caregiver within seven days after discharge from an emergency department, hospital, skilled nursing facility, or other healthcare facility.
7. Coordination With Home and Community Services
APCM goes beyond coordination among physicians.
The practice should be able to coordinate with:
- Home-based service providers
- Community-based providers
- Social-service organizations
- Hospitals
- Skilled nursing facilities
- Other members of the patient's care network
Documentation may include the patient's functional needs, psychosocial strengths, goals, preferences, and desired outcomes.
8. Enhanced Communication
CMS requires APCM practices to offer communication methods beyond traditional telephone calls.
Capabilities include:
- Secure messaging
- Email or other permitted electronic communication
- Patient portal communication
- Remote evaluation of prerecorded patient information
- Interprofessional electronic consultation
- Patient-initiated digital communications requiring clinical decisions
9. Population-Level Management
Population-level management is a major difference between APCM and traditional individual care-management services.
CMS requires APCM practices to:
- Analyze patient-population data to identify gaps in care
- Risk stratify the patient population using diagnoses, claims, or other electronic data
- Identify patients who may need targeted services
10. Performance Measurement
CMS also includes practice-level performance measurement and reporting requirements.
This includes assessment of:
- Primary-care quality
- Total cost of care
- Meaningful use of certified EHR technology
CMS provides several pathways for satisfying applicable performance requirements, including the Value in Primary Care MIPS Value Pathway and participation in certain qualifying Medicare programs or models.
Do All APCM Services Have to Be Performed Every Month?
No. CMS states that all listed APCM service elements do not have to be furnished to every patient every month.
The practice must have the required capabilities and furnish the elements that are clinically appropriate for the individual patient.
This distinction is important because APCM represents ongoing advanced primary-care capability rather than a checklist that must be mechanically repeated each month.
How Often Can G0556, G0557 or G0558 Be Billed?
CMS allows one APCM base code per patient per calendar month when requirements are met.
Practices should choose the APCM code that best reflects the patient's applicable complexity and eligibility rather than billing multiple base APCM codes for the same month.
APCM Is Not Minute Based
Unlike CPT 99490 or 99491, there is no requirement to accumulate 20 or 30 minutes before billing an APCM base code.
This does not eliminate documentation requirements. Practices should still maintain records supporting patient eligibility and the APCM services and capabilities provided.
2026 Behavioral Health Add-Ons
Beginning in 2026, CMS established optional APCM behavioral-health add-on codes G0568, G0569, and G0570.
CMS states that these codes may be reported when the appropriate APCM base code is billed by the same practitioner in the same month and all applicable behavioral-health requirements are met.
This creates an additional opportunity for practices that integrate behavioral-health services into advanced primary care.
Example: Choosing Between G0556, G0557 and G0558
Patient ScenarioCode to EvaluateLower-complexity APCM patient who meets the core APCM requirementsG0556Patient with diabetes and hypertension meeting duration and risk requirementsG0557QMB patient with diabetes, CHF, and COPD meeting APCM requirementsG0558
These examples are illustrative. The actual code should be based on the patient's documented circumstances and current CMS requirements.
Common APCM Billing Mistakes
1. Treating APCM Like a Time-Based CCM Code
CMS specifically states that APCM is not time based.
2. Using G0557 Without Supporting Two Chronic Conditions
The medical record should support two or more qualifying chronic conditions with the required duration and clinical risk.
3. Using G0558 Without Verifying QMB Status
Qualified Medicare Beneficiary status is an additional requirement for G0558.
4. Ignoring Practice-Level Requirements
APCM requires capabilities including enhanced communication, population-level management, care transitions, and performance measurement.
5. Missing Consent
Written or verbal consent should be obtained before APCM begins and documented in the record.
6. Billing More Than One APCM Base Code for the Same Month
CMS allows APCM billing once per patient per calendar month. Select the appropriate level rather than stacking the three base codes.
7. Automatically Separately Billing Included Services
Because APCM is a bundled service incorporating elements of several traditional care-management and communication services, practices should review CMS bundling rules before separately reporting overlapping services.
APCM Pre-Billing Checklist
- Confirm the practitioner is responsible for the patient's primary care.
- Confirm the practitioner serves as the continuing focal point for needed healthcare services.
- Determine whether G0556, G0557, or G0558 is supported.
- For G0557, verify at least two qualifying chronic conditions.
- For G0558, verify QMB status and at least two qualifying chronic conditions.
- Obtain and document patient consent.
- Complete an initiating visit when required.
- Maintain 24/7 access and continuity capabilities.
- Maintain a comprehensive electronic care plan.
- Support care transitions.
- Coordinate practitioner, home, and community-based care.
- Provide enhanced electronic communication capabilities.
- Perform population-level management.
- Meet applicable performance-reporting requirements.
- Review overlapping or bundled-service restrictions.
- Verify current CMS and Medicare Administrative Contractor guidance.
How ChronicSync Can Help
APCM requires practices to manage more than individual patient calls. Organizations need visibility into chronic conditions, care plans, transitions, care-team communication, follow-up needs, and population-level care gaps.
ChronicSync helps practices organize longitudinal care-management workflows, maintain structured patient documentation, coordinate patient activity, and improve visibility across chronic-care programs.
Start your ChronicSync Free Pilot and explore a more organized approach to advanced primary care and chronic care management.
Frequently Asked Questions
What are G0556, G0557 and G0558?
They are the three Medicare HCPCS base codes for Advanced Primary Care Management services.
What is G0556?
G0556 is the foundational APCM service level. CMS's MLN materials describe Level 1 as applying to patients with zero or one chronic condition, while the current CMS billing page emphasizes the core APCM staffing and primary-care requirements.
What is G0557?
G0557 applies to a patient with two or more chronic conditions that are expected to last at least 12 months or until death and create the required significant clinical risk.
What is G0558?
G0558 applies to a Qualified Medicare Beneficiary with two or more qualifying chronic conditions and includes the underlying APCM requirements.
Is APCM time based?
No. CMS states that APCM services are not time based and may be billed once per patient per calendar month when requirements are met.
Can clinical staff perform APCM services?
Yes. CMS permits auxiliary personnel to provide APCM incident to the billing practitioner's professional services under general supervision when applicable requirements are satisfied.
Does APCM require patient consent?
Yes. CMS permits written or verbal consent, which must be documented before APCM services begin.
Do all APCM elements need to be performed every month?
No. CMS states that practices should furnish the required service elements when they are clinically appropriate for the individual patient; every element does not have to be repeated every month.
Sources
- CMS: Advanced Primary Care Management Services
- CMS Medicare Learning Network: Care Management Services
- CMS: CY 2026 Medicare Physician Fee Schedule Final Rule
This article is provided for educational purposes only and does not constitute medical, legal, coding, reimbursement, compliance, or billing advice. CMS, HCPCS, Medicare Administrative Contractor, and payer requirements can change. Verify current requirements before submitting claims.