APCM Billing Guide: HCPCS G0556, G0557 and G0558 Requirements for 2026

By Jay Chowdappa, MD, co-founder and CEO, Zynix AI · Updated October 30, 2026

Key takeaways

Advanced primary care management (APCM) is a monthly Medicare bundle, billable since January 1, 2025, for the practitioner responsible for a patient's primary care. HCPCS G0556 covers patients with zero or one chronic condition, G0557 two or more, and G0558 Qualified Medicare Beneficiaries with two or more. It is not time-based, but it requires consent, practice-wide capabilities and quality reporting.

• Bill APCM once per patient per calendar month; there are no minutes to count.
• An initiating visit is needed only for new patients: none if the patient was seen in the past 3 years or had another care management service in the past year.
• The practitioner who bills APCM cannot bill CCM, PCM, TCM or certain communication technology services for that patient in the same month.
• Since 2026, optional add-ons G0568, G0569 (collaborative care) and G0570 (general behavioral health integration) can be billed with APCM.

What is advanced primary care management?

APCM combines elements of several existing services into one monthly payment: principal care management, transitional care management, chronic care management and communication technology-based services such as virtual check-ins, remote evaluation of pre-recorded information and interprofessional consultations. CMS designed it so practices bill a monthly bundle instead of counting minutes or billing each service separately.

You can bill APCM if you are a physician or a non-physician practitioner (nurse practitioner, physician assistant, certified nurse-midwife or clinical nurse specialist), you are responsible for all of the patient's primary care, you are the focal point for all their needed health care services, and you have the patient's written or verbal consent. CMS expects primary care specialties to use it most.

G0556, G0557 and G0558: which code applies?

The code depends on the patient's medical complexity and, for the top level, their Qualified Medicare Beneficiary (QMB) status.

Chronic conditions here are those likely to last at least 12 months, or until death, that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. Every patient who consents is eligible for at least Level 1.

What are the APCM billing requirements?

You must be able to furnish every element below in any month you bill, and provide each one when it is clinically appropriate for the patient. You do not have to provide all of them every month.

1. Consent. Written or verbal, documented once, telling the patient that only one provider can bill APCM in a month, that they can stop at any time, and that the Part B 20% coinsurance generally applies.
2. Initiating visit for new patients. Not needed if you or another provider in your practice saw the patient in the past 3 years, or provided APCM, CCM or PCM in the past year.
3. 24/7 access and continuity, including the ability to schedule successive routine appointments with a designated care team member, and alternatives to office visits such as home visits or expanded hours.
4. Comprehensive care management: medical and psychosocial needs assessments, system-based approaches to preventive services, and medication reconciliation, management and oversight of self-management.
5. An electronic, patient-centered comprehensive care plan that the care team can routinely access and update, available outside the practice as appropriate, with a copy to the patient or caregiver.
6. Care transitions, including timely electronic exchange of health information and follow-up with the patient or caregiver within 7 days of an emergency department visit or a discharge, as clinically indicated.
7. Coordination with practitioners, home- and community-based services and social service providers, documenting the patient's psychosocial strengths, functional deficits, goals, preferences and desired outcomes.
8. Enhanced communication: asynchronous methods beyond the phone (secure messaging, email, portal), remote evaluation of pre-recorded information, interprofessional referrals, and patient-initiated digital communications such as virtual check-ins and e-visits.
9. Population-level management: analyzing patient population data to find care gaps and grouping patients by risk using diagnoses, claims or other electronic data.
10. Performance measurement: report the Value in Primary Care MIPS Value Pathway, or participate in a Shared Savings Program ACO, the ACO REACH Model, the Making Care Primary Model or Primary Care First.

By billing APCM, the practitioner attests that these requirements were met. CMS's FAQ says practice-level capabilities do not need to be documented in each patient's record except where they were used for that patient. Auxiliary personnel can provide APCM services incident to the billing practitioner under general supervision.

Which visits count as the APCM initiating visit?

CMS's APCM FAQ lists E/M visits levels 2 through 5 (CPT 99212 to 99215), the face-to-face visit included in TCM (99495 and 99496), the Annual Wellness Visit and the Initial Preventive Physical Exam, as long as APCM is discussed during the visit. The initiating visit is paid separately. The AWV qualifies when the provider responsible for the patient's APCM performs it.

APCM vs CCM: what is different?

APCM trades CCM's minute counting for broader practice requirements and quality reporting.

For the time-based codes and their rules, see our CCM billing requirements guide.

What can and cannot be billed with APCM?

The restriction is per practitioner, not per practice. In the CY 2025 final rule, CMS finalized that the practitioner who furnishes APCM cannot bill these services for the same patient in the same month:

• Chronic care management and principal care management
• Transitional care management (99495 and 99496)
• Interprofessional consultations, remote evaluation of patient videos or images, virtual check-ins and e-visits

Another practitioner in the same practice may bill those services in the same month when they are medically necessary, for example a specialist managing a patient's care after a related admission. CMS said behavioral health integration, community health integration, principal illness navigation, remote physiologic monitoring and remote therapeutic monitoring complement APCM and may be billed with it when appropriate.

Since January 1, 2026, three optional add-on codes can be billed with an APCM base code by the same practitioner in the same month. They are not time-based, and Part B coinsurance applies:

Can FQHCs and RHCs bill APCM?

Yes. CMS's APCM FAQ says rural health clinics and federally qualified health centers can bill APCM and receive separate payment, with or without a qualifying visit, at the PFS non-facility rate. For other practices, APCM is priced in both facility and non-facility settings, and the place of service should be where the billing practitioner would ordinarily see the patient face to face.

What is next for APCM?

In the CY 2027 proposed rule (July 16, 2026), CMS said first-year APCM uptake was less than anticipated and asked for comment on whether a different payment structure would work better and how to simplify the codes and requirements. It also asked about prospective primary care payments, including capitated arrangements in the Shared Savings Program, after commenters on the 2026 rule supported giving ACOs the option of prospective monthly APCM payments. These are requests for information, not final policy. Watch the CY 2027 final rule.

Running APCM in practice

APCM pays for capabilities across a whole panel: knowing which patients have open gaps, following up within 7 days of discharges and ED visits, and keeping care plans and messages moving between visits. Zynix AI's Population Intelligence brings claims, EHR, ADT, lab and pharmacy data into one view of which patients need what, which supports the population-level management requirement. Its chronic care workflow for ACO panels runs monthly check-ins and routes symptom and adherence changes to care managers, with clinicians making every clinical decision.

This guide summarizes Medicare rules as CMS published them as of October 30, 2026. It is not legal or coding advice. CPT is a registered trademark of the American Medical Association. Check current CPT guidance, your Medicare Administrative Contractor (MAC) and each payer's policy before you change billing.

Frequently asked questions

What are HCPCS codes G0556, G0557 and G0558?

They are the three advanced primary care management (APCM) codes Medicare has paid since January 1, 2025. G0556 (Level 1) is for patients with zero or one chronic condition, G0557 (Level 2) for patients with two or more, and G0558 (Level 3) for Qualified Medicare Beneficiaries with two or more. Each is billed once per patient per calendar month by the practitioner responsible for primary care.

Is APCM time-based?

No. Unlike chronic care management, APCM does not require counting or documenting minutes. The practitioner bills once per month when the billing requirements are met, including consent, the capability to furnish every service element, and quality reporting through the Value in Primary Care MIPS Value Pathway or participation in a qualifying ACO or model.

Can you bill APCM and CCM in the same month?

Not by the same practitioner for the same patient. The practitioner billing APCM cannot bill CCM, PCM, TCM, interprofessional consultations, remote image evaluation, virtual check-ins or e-visits for that patient in that month. A different practitioner in the same practice may bill them when medically necessary, such as a specialist managing a related condition.

Do patients pay coinsurance for APCM?

Generally yes. CMS's consent requirement says patients must be told that the Part B 20% coinsurance generally applies. The 2026 behavioral health add-ons G0568, G0569 and G0570 also carry Part B coinsurance. Explain this at enrollment; some patients have supplemental coverage that pays it.

Does an ACO practice need to report the Value in Primary Care MVP to bill APCM?

No, if it participates in a Shared Savings Program ACO. CMS accepts participation in a Shared Savings Program ACO, the ACO REACH Model, the Making Care Primary Model or Primary Care First in place of reporting the Value in Primary Care MIPS Value Pathway. Other practices billing APCM report that MVP.

Related reading

• How To Automate Care Management With AI Agents
• How ACOs Actually Make Money: Shared Savings Mechanics and Where AI Moves the Needle
• AI for Value-Based Care: What It Actually Does

Source notes

CMS (page last modified October 27, 2026): Advanced Primary Care Management Services. https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-primary-care-management-services

CMS: Advanced Primary Care Management (APCM) Services FAQ. https://www.cms.gov/files/document/advanced-primary-care-management-apcm-services-faq.pdf

Federal Register, 89 FR 97710 (December 9, 2024): CY 2025 Payment Policies Under the Physician Fee Schedule, final rule. https://www.federalregister.gov/documents/2024/12/09/2024-25382/medicare-and-medicaid-programs-cy-2025-payment-policies-under-the-physician-fee-schedule-and-other

Federal Register, 90 FR 49266 (November 5, 2025): CY 2026 Payment Policies Under the Physician Fee Schedule, final rule. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other

Federal Register, 91 FR 43842 (July 16, 2026): CY 2027 Payment Policies Under the Physician Fee Schedule, proposed rule. https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-other

About the author

Jay Chowdappa, MD is co-founder and CEO of Zynix AI. He is a physician, and ACOs led by him generated $300M+ in shared savings before he started Zynix AI to help care teams follow through on what their data already shows.