March 27, 2025
Advanced Primary Care Management: What It Is & How to Get It Right
- by Shannon DeConda, Partner, Founder and President of NAMAS
If you’ve been in the billing and compliance trenches for a while, you’ve seen the evolution from Chronic Care Management (CCM) and Principal Care Management (PCM) to broader strategies that aim to reach more patients and address the complexities of chronic conditions. Enter Advanced Primary Care Management (APCM).
APCM isn’t just another acronym—it’s a strategic framework that expands the approach to proactive, coordinated cAPCM-Toolare for Medicare beneficiaries. If you’re still trying to figure out how APCM differs from CCM, PCM, or even Transitional Care Management (TCM), you’re not alone. Let’s break it down.
What Is APCM?
Advanced Primary Care Management is designed to capture the full picture of ongoing, and team-based, proactive patient care—regardless of whether the patient has two chronic conditions (like CCM), a single serious illness (like PCM), or has just been discharged from the hospital (like TCM).
Instead of focusing strictly on conditions, APCM centers around the need for care coordination, oversight, and planning—often delivered over time and involving multiple touchpoints across a care team.
- APCM applies to ALL Medicare patients
- Focus is on patient management
- Supports team-based, longitudinal care
APCM vs. CCM, PCM, and TCM
Let’s look at how these services stack up:
| Feature | CCM | PCM | TCM | APCM |
|---|---|---|---|---|
| Who’s Eligible? | Medicare patient’s w/ 2+ chronic conditions | Medicare patients w/ 1 serious condition | Medicare patients post-discharge | All Medicare patients with care coordination needs |
| When Is It Used? | Ongoing chronic care | Focused disease care | Within 30 days post-discharge | Anytime care coordination is needed |
| Who Provides It? | Clinical staff under MD/QHP supervision | MD/QHP only | MD/QHP only | Clinical staff, MD/QHP, or both |
| Codes | 99490, 99491, 99439 | 99424–99427 | 99495, 99496 | G0556, G0557, G0558 |
| Is Time Required? | Yes | Yes | Yes | No time threshold, but document scope |
Billing APCM Correctly: The Codes That Matter
APCM services are billed using G-codes, and code selection depends on who is rendering the service.
| Code | Description | Monthly Reimbursement (Est.) |
|---|---|---|
| G0556 | Clinical staff services under MD/QHP supervision | ~$17 |
| G0557 | Services provided directly by MD/QHP | ~$54 |
| G0558 | Combined physician + clinical staff services | ~$117 |
These codes do not require a minimum number of minutes. However, they do require well-documented care coordination, education, medication management, and often care planning or communication across providers.
Documentation Must-Haves
No matter who provides the service—clinical staff or physician—documentation must clearly show:
- What was done (interventions, coordination, planning)
- Why it was done (medical necessity)
- How it was delivered (in-person, phone, portal, etc.)
- Patient’s involvement and understanding
- Care plan activity or updates, if applicable
- Consent on file (one-time consent is sufficient unless revoked)
Pro tip: Time tracking is optional for APCM, but can be helpful for internal validation of the rendering provider and assist in documentation support.
Who Can Perform APCM?
One of the most flexible features of APCM is the multi-role eligibility:
- Clinical/Ancillary staff under the direction of a physician or QHP (G0556)
- Physician or QHP directly (G0557)
- Combination of both (G0558)
This allows practices to scale services across teams while remaining compliant—just make sure the documentation clearly supports who provided what and how.
Getting Started? Here’s Your Free Resource
To make it even easier, we’ve built a downloadable APCM Toolkit that walks you through:
- Service breakdowns
- Billing rules
- Documentation templates
- Audit-ready checklists
- Workflow tips
Clean Up Your Existing APCM Process
APCM is not a new code—it’s a new mindset. One that moves us away from reactive, siloed care and toward connected, intentional care delivery that supports both patients and providers.
If your organization is ready to get started—or clean up your existing APCM process—make sure your documentation speaks the language of Medicare: clear, compliant, and purposeful.
