What is Advanced Primary Care Management (APCM)?

Advanced Primary Care Management (APCM) is a Medicare program specifically designed to provide continuous, personalized care to patients. This innovative approach to healthcare management is centered on the principles of preventive care, holistic patient support, and dedicated care teams. APCM focuses on preventive care management of chronic diseases.

Advanced Primary Care Management incorporates elements of other care management programs, like Chronic Care Management, Transitional Care Management, and Principal Care Management. However, Advanced Primary Care Management is available to all Medicare patients regardless of their number of chronic conditions.

what is Advanced Primary Care Management (APCM)?

Key Benefits of APCM

For Patients

APCM Improved Care Coordination
Improved Care Coordination
Key Benefits of APCM
Better Management of Chronic Conditions
Key Benefits of APCM
Timely diagnosis and treatment
Key Benefits of APCM
Improved Patient Outcomes

For Providers

Key Benefits of APCM
Optimized Practice Workflows
Key Benefits of APCM
Focus on Value-Based Care
Key Benefits of APCM
Financial benefits for providers
Key Benefits of APCM
Risk-Stratified Reimbursement

How APCM is different from CCM and PCM?

How APCM is different from CCM and PCM?
Risk-Based Reimbursement, Not Time-Based
How APCM is different from CCM and PCM?
No Minimum Time Requirement
How APCM is different from CCM and PCM?
Broader Eligibility Beyond Chronic Conditions
How APCM is different from CCM and PCM?
Participation in quality measurement

APCM Risk-Based Levels

Level 1: HCPCS G0556

APCM services for a patient with one chronic condition (expected to last at least 12 months or until death, posing a significant risk of severe health decline) or no chronic condition. Services are provided by clinical staff under the direction of a physician or qualified healthcare professional who oversees primary care and acts as the patient’s central point of contact for all healthcare needs.

Level 2: HCPCS G0557

APCM services for patients with two or more chronic conditions that are expected to last at least 12 months or until death and pose a significant risk of severe health deterioration, including death, acute exacerbation, or functional decline. This code includes all foundational care management elements and expands upon them to ensure comprehensive, ongoing patient support.

Level 3: HCPCS G0558

APCM services for Qualified Medicare Beneficiaries (QMBs) with two or more chronic conditions that are expected to last at least 12 months or until death and pose a significant risk of severe health deterioration, including death, acute exacerbation, or functional decline. Services are provided by clinical staff under the direction of a physician or qualified healthcare professional who oversees primary care and serves as the central point of coordination for all necessary healthcare services.

Elements of APCM

  • Patient Consent
  • Initiating Visit
  • 24/7 Access
  • Continuity of Care
  • Patient- Centered Care Delivery
  • Comprehensive Care Management
  • Comprehensive and Electronic Care Plan
  • Care Transition Coordination
  • Practitioner, Home, and Community Coordination
  • Enhanced Communication Methods
  • Patient Population Data Management
  • Performance Measurement
    •
Key elements of APCM

APCM Workflow in HUMHEALTH

1
APCM Workflow

Identify Eligible Patients

2
APCM Workflow

Get Patient Consent

3
APCM Workflow

Enroll the Patient in APCM

4
APCM Workflow

Conduct an Initial Visit for New patients

5
APCM Workflow

Provide Comprehensive Care Management

6
APCM Workflow

Continuous Monitoring, Evaluation, and Care Plan Adjustment

7
APCM Workflow

One-Click Documentation

8
APCM Workflow

Timely Reimbursement

Advanced Primary Care Management (APCM) Billing Codes and Average Reimbursement

  • HCPCS Codes
  • Billing code Description
  • Average Reimbursement

  • HCPCS Codes

    G0556
    (Level 1)

  • Billing code Description

    Advanced Primary Care Management (APCM) services for patients with one chronic condition or fewer.
    Performed by a Physician, Nurse Practitioner (NP), Physician Assistant (PA), or other Qualified Health Care Professional (QHCP).

  • Average Reimbursement

    $16

  • HCPCS Codes

    G0557
    (Level 2)

  • Billing Code Descriptors

    Advanced Primary Care Management (APCM) services for patients with two or more chronic conditions.
    Performed by a Physician, Nurse Practitioner (NP), Physician Assistant (PA), or other Qualified Health Care Professional (QHCP).

  • Average Reimbursement

    $54

  • HCPCS Codes

    G0558
    (Level 3)

  • Billing Code Descriptors

    Advanced Primary Care Management (APCM) services for patients with multiple chronic conditions who are also Qualified Medicare Beneficiaries (QMBs).
    Performed by a Physician, Nurse Practitioner (NP), Physician Assistant (PA), or other Qualified Health Care Professional (QHCP).

  • Average Reimbursement

    $117

  • HCPCS Codes

    G0568

  • Billing Code Descriptors

    Initial CoCM Services (BHI Add-On)
    Psychiatric Collaborative Care Management (CoCM), initial month, furnished with APCM service. Includes initial behavioral health assessment, care plan development, registry-based tracking, psychiatric consultant review, and care manager interventions.
    Performed by a Physician or QHCP directing care, Behavioral Health Care Manager, and Psychiatric Consultant.

  • Average Reimbursement

    $162

  • HCPCS Codes

    G0569

  • Billing Code Descriptors

    Subsequent CoCM Services (BHI Add-On)
    Psychiatric Collaborative Care Management (CoCM), subsequent month, furnished in conjunction with APCM service. Includes ongoing registry tracking, psychiatric consultation, treatment adjustments, outcome monitoring, and relapse prevention planning.
    Performed by a Physician or QHCP directing care, Behavioral Health Care Manager, and Psychiatric Consultant.

  • Average Reimbursement

    $146

  • HCPCS Codes

    G0570

  • Billing Code Descriptors

    General Behavioral Health Integration (BHI) Add-On
    General Behavioral Health Integration (BHI), per calendar month, furnished with APCM service. Includes behavioral health assessment or follow-up, care planning, coordination of psychotherapy and/or medication management, and continuity of behavioral health care.
    Performed by a Physician or Qualified Health Care Professional (QHCP).

  • Average Reimbursement

    $58

*Disclaimer: This information is for informational purposes only and does not constitute legal, billing, or professional advice. Billing and coding requirements, especially in remote care management, may change or be interpreted differently over time. Always consult a qualified medical billing professional before submitting claims to ensure all requirements are met.

APCM Frequently Asked Questions (FAQs)

All Medicare beneficiaries are eligible for APCM services, including those with or without chronic conditions.

Physicians and Non-Physician Practitioners (NPP), including Nurse Practitioners (NP), Physician Assistants (PA), and Clinical Nurse Specialists (CNS), who are responsible for all patient’s primary care services, can bill for APCM services. The program is primarily intended for primary care specialties such as general internal medicine, family medicine, geriatric medicine, or pediatrics.

No, APCM codes are not time-based. Unlike some other care management services, there is no minimum time requirement to bill for APCM services. The focus is on providing comprehensive care activities that meet the patient’s needs based on their risk level, rather than the amount of time spent.

To bill for APCM services, providers must complete several elements when clinically appropriate, including:
  • Patient Consent: Obtain and document a written or verbal consent from the patient to participate in APCM services.
  • Initiating Visit: Conduct an initiating visit for new patients or those not seen within the past three years.
  • 24/7 Access: Ensure patients have 24/7 access to their care team for urgent needs
  • Comprehensive Care Management: Provide systematic needs assessments, preventive services, medication reconciliation, and oversight of patient self-management.
  • Electronic Care Plan: Develop and maintain a patient-centered comprehensive care plan that is accessible electronically to the care team and the patient.

No, APCM cannot be billed in conjunction with Chronic Care Management (CCM) or Principal Care Management (PCM) for the same patient during the same billing period.

Currently, there are no known location-specific limitations for billing APCM services. Similar to CCM and RPM services, APCM can be provided to patients in various settings, including Skilled Nursing Facilities (SNF) and Long-Term Care (LTC) facilities.

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