APCM Codes and Billing Requirements: HCPCS G0556, G0557, and G0558

Updated November 3, 2026

Advanced Primary Care Management (APCM) is Medicare's newest initiative designed to encourage providers to deliver continuous, remote care management to Medicare patients. Primary care providers — like family medicine, internal medicine, and geriatrics practitioners — as well as federally qualified health centers (FQHCs) and rural health clinics (RHCs) can furnish and bill for APCM services starting in 2025.

To bill for Advanced Primary Care Management, providers must know about the three APCM HCPCS codes — G0556, G0557, and G0558 — and their requirements for billing and reimbursement. Read on to learn all about the codes, their associated 2026 reimbursement, and the requirements APCM providers need to follow high quality primary care services. 

Overview of G0556, G0557, and G0558 

The three APCM codes — HCPCS G0556, HCPCS G0557, and HCPCS G0558 — were defined by the Centers for Medicare & Medicaid Services (CMS) in the 2025 Physician Fee Schedule final rule. They have the same general requirements, as will be discussed below, but vary based on patient medical and social complexity.  

All Medicare beneficiaries are eligible for APCM. The beneficiaries who are likely to benefit most from APCM are those with one or more chronic conditions. Reimbursement increases as patient complexity increases. 

G0556, G0557, and G0558 Code Descriptors 

Below are the code descriptors for the three APCM HCPCS codes (bolding added for emphasis). In the finalized descriptors, CMS listed the requirements (i.e., elements). For readability, we are omitting these elements from the descriptors. 

HCPCS G0556 Descriptor 

Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month. 

HCPCS G0557 Descriptor 

Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month. 

HCPCS G0558 Descriptor 

Advanced primary care management services for a patient that is a Qualified Medicare Beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month. 

G0556, G0557, and G0558 Simplified 

What are the Reimbursement Rates for APCM in 2026?

Providers billing Advanced Primary Care Management services can expect the following monthly reimbursement in 2026 for the three APCM HCPCS codes: 

• G0556 is reimbursed at approximately $16 per month. 

• G0557 is reimbursed at approximately $54 per month. 

• G0558 is reimbursed at approximately $117 per month. 

APCM Behavioral Health Add-On Codes: G0568, G0569, and G0570

The 2026 Physician Fee Schedule added three optional codes for behavioral health care delivered alongside APCM. Each must be billed with an APCM base code (G0556, G0557, or G0558) for the same patient in the same month. None have a time requirement, and FQHCs and RHCs can bill all three.

G0568: Initial Psychiatric Collaborative Care Management

G0568 covers the first month of collaborative care, delivered by a behavioral health care manager in consultation with a psychiatric consultant. It includes:

• An initial assessment with validated rating scales
• An individualized treatment plan reviewed by the psychiatric consultant
• Entering the patient in a registry
• Weekly caseload consultation
• Brief evidence-based interventions

G0568 is reimbursed at approximately $162 per month.

G0569: Subsequent Psychiatric Collaborative Care Management

G0569 covers each following month of collaborative care. It includes:

• Ongoing registry tracking
• Weekly caseload consultation
• Treatment adjustments based on the psychiatric consultant’s recommendations
• Outcome monitoring with validated rating scales
• Relapse prevention planning

G0569 is reimbursed at approximately $146 per month.

G0570: General Behavioral Health Integration

G0570 covers monthly behavioral health care management without the full collaborative care model. It requires no psychiatric consultant or registry, which makes it the most practical starting point for many practices. It includes:

• Assessment or monitoring with validated rating scales
• Behavioral health care planning
• Coordinating treatment such as psychotherapy or medication
• Continuity with a designated care team member

G0570 is reimbursed at approximately $58 per month.

APCM Billing Codes Requirements 

To bill for any of these APCM HCPCS codes, providers must be prepared to deliver 13 service elements to enrolled Medicare beneficiaries. Not all services must be provided each month. However, the provider organization must be capable of delivering all the APCM service elements. 

The following are CMS's requirements to bill the three APCM codes (bolding added for emphasis): 

1. Consent:
   1. Inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. 
   2. Document in patient’s medical record that consent was obtained. 
2. Initiation during a qualifying visit for new patients or patients not seen within 3 years.
3. Provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week.
4. Continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments.
5. Deliver care in alternative ways to traditional office visits to best meet the patient’s needs, such as home visits and/or extended hours.
6. Overall comprehensive care management:
   1. Systematic needs assessment (medical and psychosocial). 
   2. System-based approaches to ensure receipt of preventive services.  
   3. Medication reconciliation, management and oversight of self-management.
      
7. Development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan with typical care plan elements when clinically relevant:
   1. Care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary’s care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver.
      
8. Coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable:
   1. Ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. 
   2. Ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated.
9. Ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient’s medical record.
10. Enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary’s care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/EHR referral service(s), to maintain ongoing communication with patients, as appropriate: 
    1. Ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and E/M visits (or e-visits).
11. Analyze patient population data to identify gaps in care and offer additional interventions, as appropriate.
12. Risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients.
13. Be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of Certified EHR Technology).

Note: The following image lists the 13 elements and may be a useful reference when working to ensure compliance with the APCM code requirements. 

13 APCM Service Elements

Patient consent

Initiating visit

Continuity of care

Alternative care delivery

Comprehensive care management

Patient-centered care plan

24/7 Access to care

Care transitions coordination

Ongoing communication

Enhanced communication

Population data analysis

Risk stratification

Performance measurement

Take It With You: Prevounce APCM Billing Guide 

We hope you found the information above helpful to understanding the three new APCM HCPCS codes. To assist you even further, we've published a "Advanced Primary Care Management Billing Guide" that summarizes this piece and includes additional information on topics like the projected APCM revenue for a practice with 1,000 Medicare patients, the clinical and financial value of pairing APCM with remote patient monitoring (RPM), and projected revenue for those same 1,000 APCM Medicare beneficiaries who also receive RPM services. Download this APCM billing guide here. 

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Frequently Asked Questions About APCM Billing and Coding Requirements

 Does APCM have care time requirements? 

No. Unlike chronic care management (CCM), which requires a minimum number of clinical staff minutes each month, APCM codes G0556, G0557, and G0558 have no monthly time thresholds. Practices bill based on the patient’s complexity level and their ability to furnish the 13 required APCM service elements, not on minutes spent, but good-faith programs should regularly spend time communicating with patients and reviewing and updating care plans. The 2026 behavioral health add-on codes (G0568, G0569, and G0570) also have no time-based requirements.

Can FQHCs and RHCs bill for Advanced Primary Care Management (APCM)?

Yes, FQHCs and RHCs are able to bill for APCM using the standard set of HCPCS codes. FQHCS and RHCs often have a higher level of Qualified Medicare Beneficiaries, that provide greater clinical and financial opportunities for APCM programs. 

Can APCM codes be billed in the same month as Remote Patient Monitoring (RPM)?

Yes, APCM can be billed in conjunction with RPM, and both programs align to deliver more informed, more comprehensive remote care. However, APCM can't be billed with services CMS considers overlapping, like chronic care management (CCM). 

How often must a patient-centered care plan be updated for APCM?

There is no prescribed requirement for keeping patient care plans updated, except that it be updated as clinically necessary. CMS requires the care plan be a "living document" that is routinely reviewed and adjusted to reflect changes in the patient's health status or goals. 

Are there APCM CPT codes?

No, APCM uses HCPCS codes G0556, G0557, and G0558, not CPT codes. CMS created APCM specifically as a new HCPCS code set in the 2025 Physician Fee Schedule final rule. The distinction doesn't affect billing eligibility, just make sure your claims reference G0556, G0557, or G0558, not a CPT number.