Advanced Primary Care Management (APCM) Made Simple
Why It Matters?
For doctors and practices, APCM is like clearing a messy desk—less paperwork, more predictable payments, and more time to focus on patients. For patients, it feels like someone is always looking out for you—not just during appointments, but in between. It’s about whole-person care, rather than fragmented, program-by-program attention. Given these benefits, it is essential to identify which healthcare professionals are eligible to provide these services.Who Can Use APCM?
APCM can be billed by:
- Physicians (MD, DO)
- Nurse Practitioners (NPs)
- Physician Assistants (PAs)
- Clinical Nurse Specialists (CNS)
APCM Levels & Payments
Medicare structures APCM into three distinct levels. Specifically, these levels depend on patient complexity. G0556 – Patients with 0–1 chronic condition (lowest payment) G0557 – Patients with 2+ chronic conditions (medium payment) G0558 – Patients with 2+ chronic conditions + QMB status (highest payment) To earn these payments, providers must offer specific monthly services. In fact, Medicare mandates that these services remain available at all times.What Services are Included?
APCM requires providers to offer a set of services every month. Not all need to happen every time, but they must always be available:
- A one-time patient consent conversation
- An initial visit to get you started (if you haven’t been seen recently)
- 24/7 access to the care team
- Medication and care management
- Preventive care and health planning
- Coordination when you leave the hospital
- Regular check-ins (phone, video, or secure messaging)
- A care plan tailored to your needs
- Tracking progress and reporting on quality
How Often is APCM Billed?
As a standard rule, APCM is billed once per month per patient. To remain compliant, however, practices must keep a few key limitations in mind. First, APCM cannot be billed in the same month as certain other programs, such as CCM or TCM. Additionally, patients must give fresh consent specifically for this program. Typically, practices bill APCM once per month per patient. However, you must follow strict limitations. Specifically, you cannot bill APCM and CCM in the same month. Additionally, patients must provide fresh consent for this track. Consequently, enrollment does not roll over automatically from other programs.WellWink Health, LLC is a leading technology company that specializes in providing innovative solutions for the healthcare industry. With a dedicated focus on patient engagement and care coordination (CCM/RPM), our mission is to empower medical practices and healthcare facilities to deliver exceptional patient experiences and improve overall health outcomes.
To get in touch call us right now at (848)-291-2430 to learn more about our CCM program or you can also book a 30 min free consultation.
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