APCM billing and coding requirements
In the 2025 Medicare Physician Fee Schedule (MPFS) final rule, CMS established coding and payment for a new set of advanced primary care management (APCM) services.
These APCM services bundle several existing care management and communication technology-based services that many organizations currently bill for their patients, according to CMS. These bundled services reflect elements of principal, transitional, and chronic care management.
Beginning January 1, 2025, organizations can use one of the following HCPCS codes to bill for APCM services:
- G0556 (APCM for patients with up to one chronic condition)
- G0557 (APCM for patients with multiple chronic conditions)
- G0558 (APCM for Qualified Medicare Beneficiaries with multiple chronic conditions)
Unlike codes for traditional care management services, these codes are not time-based, which will help to reduce administrative burden, according to CMS. Organizations can bill for these services using a monthly bundle per patient.
Physicians, non-physician practitioners, physician assistants, and clinical nurse specialists can bill for APCM services after the new requirements take effect, says CMS. These providers must be responsible for all of the patient’s primary care services, act as the focal point for their needed healthcare services, and receive their verbal or written consent.
Organizations must meet additional requirements to bill for APCM services when clinically appropriate, such as the following:
- Conduct an initiating visit (paid separately)
- Provide comprehensive care management
- Coordinate care transitions
- Measure and report performance
APCM services will primarily be used in primary care specialties, such as family medicine or pediatrics, according to CMS. Auxiliary personnel can provide these services incident to the professional services of the provider who bills the initiating visit and related APCM services.
Revenue integrity professionals can view the 2025 MPFS final rule and CMS’ webpage on APCM services for more information.