Advanced Primary Care Management (APCM) is a Medicare monthly bundle for ongoing primary care management, billed with three tiered codes — G0556, G0557, and G0558 — that scale by patient complexity rather than by time. Unlike Chronic Care Management, APCM has no minute thresholds; billing depends on the patient's condition count and eligibility status.

APCM was introduced by CMS to pay primary care practices for the continuous, between-visit work of managing a patient panel — care coordination, access, and follow-up — under one recurring code instead of several time-based ones. It consolidates elements that practices previously billed through separate care management services.

What is Advanced Primary Care Management?

APCM is a set of care management services delivered by a primary care team to a patient with an established relationship to the practice. It bundles capabilities that were previously spread across Chronic Care Management (CCM), Principal Care Management (PCM), and communication technology-based services into a single monthly service.

The defining feature is that APCM is not time-based. Traditional care management codes require documenting a threshold of clinical staff or practitioner minutes each month. APCM instead pays a monthly amount tied to the patient's complexity tier, as long as the required service elements are in place. That removes the minute-counting that made CCM administratively heavy for many practices.

To bill APCM, the practice generally must offer a defined set of capabilities to the patient — an initiating visit for new patients, 24/7 access to care and continuity with a designated care team member, comprehensive care management, an electronic care plan, care coordination across settings, and enhanced communication (patient portal, secure messaging, and asynchronous options). Confirm the current element list and any documentation requirements against CMS guidance for the billing year.

What do G0556, G0557, and G0558 mean?

The three APCM codes describe the same service at three levels of patient complexity:

• G0556 — Level 1: a patient with one or fewer chronic conditions. This is the lightest tier, intended for relatively healthy patients who still benefit from continuous primary care management.
• G0557 — Level 2: a patient with two or more chronic conditions expected to last at least 12 months (or until death). This is the standard multi-morbidity tier and typically the most commonly billed.
• G0558 — Level 3: a patient with two or more chronic conditions who is also a Qualified Medicare Beneficiary (QMB) — a marker of dual eligibility and higher social and clinical complexity. This tier carries the highest payment to reflect that added need.

Only one APCM code is billed per patient per calendar month, and the tier reflects that patient's status. Because Level 3 keys off QMB/dual-eligible status, practices serving a large dual-eligible population will see more G0558 billing. Payment amounts differ by tier and change year to year — confirm current CMS values before modeling revenue.

How is APCM different from CCM and PCM?

The clearest difference is time. CCM and PCM are time-threshold codes; APCM is not. CCM requires a set number of care management minutes per month, with add-on codes for additional time. PCM focuses on a single high-risk condition and also counts time. APCM replaces the stopwatch with complexity tiers and a required-capabilities checklist.

A few practical contrasts:

• Structure. CCM/PCM pay per block of documented time; APCM pays a flat monthly amount by tier.
• Scope. PCM manages one serious condition; CCM manages multiple chronic conditions; APCM covers the whole primary care management relationship regardless of condition count (which is why even a low-complexity patient can be billed under G0556).
• Concurrency. APCM is generally intended to be billed instead of CCM/PCM for the same patient in the same month, not on top of them. Check current CMS rules on which services can and cannot be reported together.

For many practices, APCM is best understood as a simplification: one recurring code that captures the ongoing management work, without the monthly minute-tracking that suppressed CCM adoption.

How does behavioral health fit with APCM?

APCM covers primary care management — it does not include behavioral health treatment. Behavioral health integration is billed separately and can generally be layered on top of APCM for the same patient.

The two main behavioral health pathways are:

• The Collaborative Care Model (CoCM), billed with its own codes (such as 99492, 99493, 99494, and G2214), which pays a primary care practice to treat depression, anxiety, and related conditions with a behavioral health care manager and a consulting psychiatrist. CoCM is time-based and measurement-based, with a large randomized-trial evidence base behind it.
• General Behavioral Health Integration (BHI), billed with 99484, for structured behavioral health management that doesn't use the full collaborative care team.

Because APCM handles the medical management and CoCM/BHI handle the behavioral health treatment, a practice can bill both for a patient who needs both — the codes address different work. This is how primary care practices and physician networks increasingly build a combined "manage the whole patient" model: APCM for continuous primary care management, collaborative care for the behavioral health side. Confirm current concurrent-billing rules and any consent or documentation requirements with CMS and your payers.

Who can bill APCM, and for which patients?

APCM is billed by the primary care practitioner or practice that holds the continuous, longitudinal relationship with the patient — the clinician the patient identifies as their main source of primary care. A patient should be attributed to one practice for APCM, not several.

Eligibility centers on that established relationship and, for new patients, an initiating visit. The tier is then set by the patient's chronic-condition count and, for Level 3, QMB status. Beyond Medicare, coverage under Medicaid and commercial plans varies by payer and state — treat any non-Medicare coverage as something to verify plan by plan.

Frequently asked questions

What are the APCM codes for 2026?

APCM is billed with three HCPCS codes: G0556 (Level 1, one or fewer chronic conditions), G0557 (Level 2, two or more chronic conditions), and G0558 (Level 3, two or more chronic conditions plus Qualified Medicare Beneficiary status). One code is billed per patient per month.

Is APCM time-based like CCM?

No. That is the main difference. CCM and PCM require documenting a threshold of care management minutes each month, while APCM pays a flat monthly amount based on the patient's complexity tier and the required service elements being in place.

Can you bill APCM and CCM in the same month?

Generally APCM is billed instead of CCM or PCM for the same patient in the same month, not in addition to them. Billing rules on concurrent services change, so confirm the current CMS guidance before reporting them together.

Can behavioral health be billed alongside APCM?

Yes. APCM does not include behavioral health treatment, so collaborative care codes (99492–99494, G2214) or general BHI (99484) can generally be billed on top of APCM for the same patient, because they cover different work. Verify current concurrent-billing rules.

How much does APCM pay?

Payment differs by tier — Level 3 (G0558) pays the most and Level 1 (G0556) the least — and CMS updates the amounts each year. Confirm current CMS values rather than relying on prior-year figures.