General Payment Structure
APCM is billed once per calendar month per patient under the Medicare Physician Fee Schedule, using one of three HCPCS codes (G0556, G0557, G0558) depending on the patient's chronic-condition tier. Unlike CCM, there's no minute-based add-on — the tier alone determines the monthly amount.
Payment Categories
G0556 applies to patients with 0 or 1 chronic condition, G0557 to patients with 2 or more chronic conditions, and G0558 to patients with 2 or more chronic conditions who are also Qualified Medicare Beneficiaries. Each tier has its own payment amount, generally increasing from G0556 to G0558.
Why Rates Vary
Like other Physician Fee Schedule payments, the APCM national amount is adjusted by a Geographic Practice Cost Index (GPCI) for locality, and the schedule itself is updated at least annually. A single national figure is a reference point, not a guarantee of what a specific practice will be paid.
Geographic Adjustment
Use the CMS Physician Fee Schedule Look-Up Tool (linked below) to check the locality-adjusted amount for a specific area rather than relying on a national average alone.
Provider/Practice Factors
APCM billing is tied to whichever practitioner serves as the patient's continuing, comprehensive primary care focal point for that month — only one provider can bill APCM per patient per month.
Current Configured Rates
| Code | Description | National Amount | Year | Status |
|---|---|---|---|---|
| G0556 | Advanced Primary Care Management, Level 1 — patients with 0 or 1 chronic condition, billed once per calendar month | $15.20 | 2025 | Pending verification |
| G0557 | Advanced Primary Care Management, Level 2 — patients with 2 or more chronic conditions, billed once per calendar month | $48.84 | 2025 | Pending verification |
| G0558 | Advanced Primary Care Management, Level 3 — patients with 2 or more chronic conditions who are also Qualified Medicare Beneficiaries, billed once per calendar month | $107.07 | 2025 | Pending verification |
National, non-facility figures with no locality adjustment. Managed in ChronicSync's admin panel — see Official Resources to verify against the live CMS Physician Fee Schedule Look-Up Tool.
Payment Updates
CMS reviews and updates Physician Fee Schedule amounts at least annually. ChronicSync reviews the configured rates above on the same cadence and whenever CMS publishes a new final rule.