The basics
What is Advanced Primary Care Management?
APCM is a Medicare monthly payment for primary care practices that provide ongoing, whole-person care management. It started in 2025 and uses three HCPCS codes: G0556, G0557, and G0558.
How is APCM different from CCM?
APCM has no monthly minute threshold and covers a broader set of primary-care capabilities. CCM is built around documented time for patients with two or more chronic conditions.
Which APCM code applies to a patient?
G0556 covers patients with zero or one chronic condition. G0557 covers two or more chronic conditions. G0558 covers two or more chronic conditions for a Qualified Medicare Beneficiary.
Can APCM be billed with other services?
Some services can, such as annual wellness visits and the G0568 to G0570 behavioral health add-ons. CMS treats several care-management services, including CCM and PCM, as duplicative when the same practitioner bills them for the same patient and month.
Patients and consent
Does the patient have to consent?
Yes. Written or verbal consent is required before services begin and must be documented. It only needs to be obtained once.
Is there a cost to the patient?
Medicare Part B cost sharing may apply. Patients must be told this during consent. Supplemental coverage or Medicaid may cover some or all of it.
Is an initiating visit required?
An initiating visit is required for new patients or patients not seen in the past three years. Check current CMS guidance for the details.
Running a program
Does every service element have to happen every month?
No. Services are furnished as clinically appropriate, but the practice must be able to provide every required element during a billed month.
Can a vendor run APCM for the practice?
A vendor can run operations like outreach, documentation, and review preparation. The billing practitioner and practice stay responsible for clinical care, required capabilities, and billing.
Does Compound Care submit claims?
No. Compound Care prepares evidence packets for internal and then practice review. Your team makes the final coding decision and submits claims through its own process.
Where does Compound Care operate?
The current pilot supports primary care practices in California.