Advanced Primary Care Management (APCM): Billing G0556, G0557 and G0558
APCM is Medicare’s newest care-management benefit — no monthly time tracking, just a per-patient monthly payment tiered by complexity. Here are the 2026 rates, the 13 service elements, and how it stacks with RPM.
APCM is the care-management code primary care has wanted for years: a per-patient monthly payment, tiered by complexity, with no minute-counting. Introduced by Medicare in 2025, it trades CCM's stopwatch for a set of capabilities you keep available — a much easier program to run at scale.
What APCM is
Advanced Primary Care Management pays practices to deliver continuous, largely remote care management to Medicare patients. Family medicine, internal medicine, geriatrics, FQHCs, and RHCs can all bill it. The defining feature: you're paid for making 13 service elements available each month, not for logging a minimum number of minutes.
The three tiers and 2026 rates
| Code | Patient | ~2026/month |
|---|---|---|
| G0556 | 0–1 chronic condition | ~$16 |
| G0557 | 2+ chronic conditions | ~$54 |
| G0558 | QMB + 2+ chronic conditions | ~$117 |
Because it's per patient per month, APCM scales into meaningful revenue across a primary-care panel.
The 13 service elements
To bill APCM you must make these available (not necessarily use all each month): patient consent, an initiating visit, 24/7 access, care continuity, alternative care delivery, comprehensive care management, a patient-centered care plan, care-transition coordination, ongoing and enhanced communication, population data analysis, risk stratification, and performance measurement. Consent must be obtained before you start billing.
APCM pays for capability, not minutes. Build the 13 elements once and every eligible patient becomes billable each month.
What it stacks with (and what it doesn't)
APCM cannot be billed in the same month as CCM, PCM, or TCM for the same patient — but it can be billed alongside RPM. Also note: starting with the 2025 performance year, practices billing APCM must report on the Value in Primary Care MIPS Value Pathway in 2026. Building the workflow and tracking eligibility is where revenue cycle management support earns its keep.
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The bottom line
APCM is CCM without the stopwatch — simpler to run, tiered by complexity, and stackable with RPM. Stand up the 13 elements, capture consent, and choose the right tier per patient, and it becomes durable monthly revenue. Start with a free billing audit.
Sources
Frequently asked questions
G0556 for patients with zero or one chronic condition, G0557 for two or more chronic conditions, and G0558 for Qualified Medicare Beneficiaries with two or more chronic conditions. They are billed once per patient per month.
Roughly $16 per month for G0556, about $54 for G0557, and about $117 for G0558 — per patient, per month, with no minimum time requirement.
No. Unlike CCM, APCM has no monthly minimum-minutes threshold. Instead, you must make 13 defined service elements available to the patient each month. This is a major operational simplification.
APCM cannot be billed in the same month as CCM, PCM, or TCM for the same patient, but it can be billed alongside Remote Patient Monitoring (RPM).
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