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

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 2025 reimbursement, and the requirements APCM providers need to follow. 

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 

Another — and helpful — way to understand the three APCM HCPCS codes is to define them by complexity level, as CMS does in the final rule: 

• "Level 1" APCM complexity — G0556 — is for patients with one or fewer (i.e., zero) chronic conditions. 

• "Level 2" APCM complexity — G0557 — is for patients with two or more chronic conditions. 

• "Level 3" APCM complexity — G0558 — is for patients who are Qualified Medicare Beneficiaries (QMB) and have two or more chronic conditions. 

G0556, G0557, and G0558 Reimbursement: 2025 Rates 

Providers billing Advanced Primary Care Management services can expect the following monthly reimbursement in 2025 for the three APCM HCPCS codes: 

• G0556 is reimbursed at approximately $15 per month. 

• G0557 is reimbursed at approximately $50 per month. 

• G0558 is reimbursed at approximately $110 per month. 

APCM Billing Codes Requirements 

To bill for any of these APMC 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. 

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 "2025 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), RPM CPT codes and their approximate reimbursement, and projected revenue for those same 1,000 APCM Medicare beneficiaries who also receive RPM services. Download this APCM billing guide here.