Code Overview
| Code | General Patient/Risk Category | General Billing Purpose | Relationship to APCM Model |
|---|---|---|---|
| G0556 | 0 or 1 chronic condition (Level 1) | Bundled monthly primary-care management payment | Entry tier — lowest condition burden |
| G0557 | 2 or more chronic conditions (Level 2) | Bundled monthly primary-care management payment | Mid tier — matches CCM's general eligibility population |
| G0558 | 2 or more chronic conditions and Qualified Medicare Beneficiary status (Level 3) | Bundled monthly primary-care management payment | Highest tier — adds QMB status to Level 2's criteria |
Current year: 2025 configured rates (see Official Resources to verify the current CMS Physician Fee Schedule Look-Up Tool figure).
How These Codes Differ From CCM Codes
Where CCM's codes (99490, 99439, 99487, 99489) key off clinical staff or practitioner time each month, APCM's codes key off which tier a patient's documented chronic-condition profile falls into — no monthly minute count is required. See our CCM CPT Codes overview for the time-based family.
Choosing the Right Code
A practice reassesses each enrolled patient's chronic-condition count (and QMB status) and bills the matching tier for that month — G0556, G0557, or G0558 — rather than selecting a code based on time spent.