What is APCM (Advanced Primary Care Management)?

Last reviewed May 12, 2026

Definition

Advanced Primary Care Management (APCM) is the Medicare reimbursement framework introduced by CMS in the Calendar Year 2025 Physician Fee Schedule Final Rule. It bundles prior care-management activities into a tiered per-member-per-month (PMPM) payment, billed under three HCPCS codes — G0556, G0557, and G0558 — based on patient complexity. APCM replaces the per-time-increment billing logic of predecessor codes.

The three tiers

CMS structured APCM as a single PMPM payment with patient assignment to one of three tiers:

G0556 — Tier 1: Patients with one chronic condition or who qualify as a new APCM patient. The lowest-complexity tier and the lowest PMPM rate.
G0557 — Tier 2: Patients with two or more chronic conditions. The middle tier, capturing the bulk of typical primary-care chronic-care panels.
G0558 — Tier 3: Patients who are Qualified Medicare Beneficiaries (QMBs) with two or more chronic conditions. The highest-complexity tier and the highest PMPM rate, reflecting the additional social and clinical complexity associated with dual-eligible patients.

A practice bills one APCM code per patient per calendar month for the duration of enrollment, at the rate corresponding to the patient’s assigned tier.

What APCM consolidates

The CY2025 Final Rule positioned APCM as a successor framework that bundles activities previously billed under separate code families. The activities encompassed by APCM include those historically captured by:

Chronic Care Management (CCM) — non-face-to-face management of patients with multiple chronic conditions (codes 99490, 99439, 99487, 99489, 99491).
Principal Care Management (PCM) — disease-specific care management for a single high-risk chronic condition.
Transitional Care Management (TCM) elements — post-discharge coordination activities, where appropriate to ongoing management.

CMS designed APCM so that a practice does not bill APCM and CCM (or APCM and PCM) for the same patient in the same month. The frameworks are alternatives, not stackable layers.

Reduced documentation burden

A core rationale CMS articulated for APCM in the CY2025 Final Rule was to reduce the time-tracking and documentation overhead that constrained CCM uptake. Under CCM, practices had to document specific time thresholds (e.g., at least 20 minutes of clinical staff time for 99490) and track incremental time for add-on codes. APCM does not require monthly time-threshold documentation in the same form — billing is tied to patient assignment to a tier and to the practice meeting the framework’s care-management capability requirements, not to minutes logged per month.

Behavioral health add-on codes (CY2026)

In the CY2026 Physician Fee Schedule Final Rule, CMS finalized a set of APCM-aligned behavioral health add-on codes — G0568, G0569, and G0570 — that allow practices billing APCM to also bill for integrated behavioral health services delivered to the same patient population, under the same Taxpayer Identification Number (TIN). This effectively extends APCM into a combined medical and behavioral care-management reimbursement framework.

How APCM is reimbursed

APCM is reimbursed under the Medicare Physician Fee Schedule. CMS publishes national PMPM rates for G0556, G0557, and G0558 annually, with geographic adjustment via the standard Medicare Geographic Practice Cost Index (GPCI). Practices bill Medicare directly under their TIN; APCM is not paid through a separate care-management contract or capitation arrangement.

Primary sources

Centers for Medicare & Medicaid Services. CY2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F). Federal Register, November 2024.
Centers for Medicare & Medicaid Services. CY2026 Medicare Physician Fee Schedule Final Rule. Federal Register, November 2025.
CMS HCPCS Level II code descriptors for G0556, G0557, G0558, G0568, G0569, G0570.

For a strategic overview of why APCM matters for primary-care practices, see The APCM Opportunity. For comparison with the predecessor framework, see What is CCM?. For the behavioral health extension, see What is BHI?. For the payment structure, see What is PMPM?.