Advanced Primary Care Management, without the stopwatch
APCM pays primary care practices a flat monthly rate per patient — no 20-minute time logs, no per-minute documentation. Hoss Care turns every APCM service element into a structured workflow your team can actually run, with the audit trail to prove it.
A monthly payment for being the practice your patients rely on
Introduced in the CY2025 Medicare Physician Fee Schedule, APCM bundles the work primary care already does — care plans, transitions, coordination, 24/7 access — into one monthly payment per enrolled patient. It replaces CCM-style minute counting with a simple attestation that the service elements are in place and delivered.
- Flat monthly payment per enrolled patient — no time thresholds
- Three complexity tiers, starting at just one chronic condition
- Billed by the practitioner who is the patient's continuing focal point of care
- Cannot be billed alongside CCM, PCM, or TCM for the same patient in the same month
Patients with one chronic condition
Patients with two or more chronic conditions
Two or more chronic conditions and Qualified Medicare Beneficiary status
Approximate CY2025 national non-facility averages. Rates change each year with the Physician Fee Schedule — verify current-year rates in the CMS PFS Lookup Tool.
Which program fits your practice?
Both reimburse ongoing care management. The difference is how you document it — and which patients qualify.
| Chronic Care Management (CCM) | APCM | |
|---|---|---|
| Time tracking | Requires logging 20+ minutes of clinical staff time each month | No minute thresholds — payment is per patient, per month |
| Billing structure | CPT 99490/99439 time-based codes, add-on codes for extra time | Three flat monthly tiers (G0556, G0557, G0558) set by patient complexity |
| Eligibility | Two or more chronic conditions required | Tiered — even patients with one chronic condition qualify at Level 1 |
| Best fit | Practices with dedicated care-management staffing and time logs | Primary care practices that are the patient's continuing focal point of care |
Running both? Many practices keep Chronic Care Management for specialist-led patients and enroll their primary care panel in APCM. We help you segment eligibility patient by patient.
Element-by-element checklists
Every APCM service element becomes a tracked workflow with owner, status, and evidence.
No stopwatch, full audit trail
APCM drops minute logs, not accountability. Every patient action is documented automatically.
Panel segmentation
We flag which patients fit APCM, CCM, or PCM so no one is billed in two programs at once.
Clean monthly claims
Tier assignment (G0556–G0558) and consent status roll into billing-ready monthly reports.
CMS defines the service elements. We operationalize them.
To bill APCM, your practice attests that these capabilities are in place and delivered. Hoss Care maps each one to a concrete, documented workflow:
- Patient consent and an initiating visit for new patients
- 24/7 access to care and continuity with the care team
- Comprehensive care management and a patient-centered care plan
- Management of care transitions after discharges and ED visits
- Practitioner, home-, and community-based care coordination
- Enhanced communication: secure messaging, email, and patient portal
- Population-level analysis and risk stratification of your panel
- Performance measurement of quality, cost, and utilization
Common questions about APCM
What is Advanced Primary Care Management (APCM)?
APCM is a Medicare care-management program introduced in the CY2025 Physician Fee Schedule. It pays primary care practices a flat monthly rate per enrolled patient (HCPCS codes G0556, G0557, G0558) for delivering a defined set of care-management service elements — without the per-minute time tracking that CCM requires.
What are the APCM billing codes and payment tiers?
APCM has three tiers: G0556 for patients with one chronic condition (approximately $15/month), G0557 for patients with two or more chronic conditions (approximately $50/month), and G0558 for patients with two or more chronic conditions who are Qualified Medicare Beneficiaries (approximately $110/month). Figures are CY2025 national non-facility averages — rates change each year with the Physician Fee Schedule.
How is APCM different from CCM?
The biggest difference is time tracking: CCM pays for documented clinical staff minutes each month, while APCM pays a flat monthly rate per patient with no minute thresholds. APCM also covers patients with a single chronic condition at its first tier, while CCM requires two or more. A patient can be enrolled in APCM or CCM in a given month, but not both.
Can we bill APCM and CCM for the same patient?
No. APCM cannot be billed in the same month as CCM, PCM, or TCM for the same patient, and only one practitioner — the one serving as the patient's continuing focal point for care — may bill APCM for a patient each month. Practices typically segment their panel, using APCM for primary care patients and CCM/PCM where a specialist leads care.
What does a practice have to do to bill APCM?
The billing practitioner must obtain patient consent, complete an initiating visit for new patients, and attest to delivering APCM's service elements — including 24/7 access, a comprehensive care plan, care-transition management, population-level analysis, and performance measurement. Hoss Care operationalizes each element as a structured workflow with audit-ready documentation.
Ready to enroll your panel in APCM?
We'll walk through your patient panel, model the three tiers against your population, and map every service element to a workflow your team can run from day one.
Book a demo