APCM Explained: G0556, G0557 and G0558 in 2026

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

Advanced Primary Care Management (APCM) is a Medicare monthly bundle that pays primary care practices for between visit care management without tracking minutes. Practices bill one of three HCPCS codes, G0556, G0557 or G0558, once per patient per month, based on chronic conditions and Qualified Medicare Beneficiary status. In 2026 the national payments are about $16, $54 and $117 a month.

Most of what keeps a chronic patient stable happens between visits, and APCM is Medicare's first attempt to pay for that work without a stopwatch.

Key facts

• APCM billing began on January 1, 2025, and it's open to physicians and nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists who are responsible for all of a patient's primary care, per CMS.
• The three levels pay about $16 (G0556), $54 (G0557) and $117 (G0558) a month in 2026, with total non facility RVUs of 0.49, 1.61 and 3.51, per AAFP Family Practice Management.
• APCM isn't time based, and CMS says you don't have to provide every service element every month, per CMS.
• Three optional add on codes for behavioral health integration and collaborative care (G0568, G0569, G0570) took effect January 1, 2026, per CMS MLN Matters MM14315.
• In 2025, APCM drew 2.49 million beneficiary months and $130.7 million in allowed spending, per the Primary Care Collaborative report released October 29, 2026.
• About 344,000 beneficiaries got APCM in the fourth quarter of 2025, or 1.2% of fee for service Medicare, per Medical Economics reporting on the PCC analysis.
• In a December 2025 survey of 404 primary care clinicians, 14.9% used APCM and 43.6% had never heard of it, per the Journal of General Internal Medicine.

What is APCM and who can bill it?

APCM is a monthly payment for the work of running advanced primary care. CMS built it from pieces of principal care management, transitional care management and chronic care management, plus communication services such as virtual check ins and interprofessional consultations.

The billing practitioner has to be responsible for all of the patient's primary care and act as the focal point for everything the patient needs. That's why family medicine, internal medicine, geriatrics and pediatrics are the usual users. In the first year, 93.6% of claims came from primary care clinicians, led by family medicine at 33.6%, nurse practitioners at 28.7% and internal medicine at 27.0%.

Only one practitioner can bill APCM for a patient in a calendar month. The patient has to consent, verbally or in writing, and you document it in the record. You only need consent once, but the consent has to cover three points:

1. Only one provider can be paid for APCM in a month.
2. The patient can stop at any time.
3. A 20% Part B copayment generally applies.

How much does Medicare pay for APCM in 2026?

Medicare pays about $16 a month for Level 1, $54 for Level 2 and $117 for Level 3 at the national non facility rate. Your actual payment moves with your locality, so check your MAC's fee schedule before you model revenue.

Here's how each code works:

• G0556: the patient has one or fewer chronic conditions. About $16 a month in 2026.
• G0557: the patient has two or more chronic conditions. About $54 a month. This is the workhorse, with about 80% of 2025 claims and 68% of allowed dollars.
• G0558: the patient is a Qualified Medicare Beneficiary with two or more chronic conditions. About $117 a month.

Level 3 depends on QMB status, not on how sick the patient is. Verify eligibility through your usual checks before you assign it.

A worked example shows why practices pay attention. This one is an illustration, not a forecast:

• A practice has 300 Medicare patients with two or more chronic conditions.
• 40% consent, so 300 x 0.40 = 120 enrolled patients.
• 120 patients x $54 = $6,480 a month.
• $6,480 x 12 months = $77,760 a year, before any locality adjustment.

The patient's share matters too. At 20% of $54, a patient without supplemental coverage owes about $10 a month.

What must a practice provide to bill APCM?

CMS expects the practice to have the capability to deliver a defined set of services, as clinically appropriate for each patient. You don't have to deliver every element every month, and you don't log time.

The elements in CMS's description are:

1. Consent, plus an initiating visit for new patients or anyone not seen in the past three years. The Annual Wellness Visit can serve as that visit if the APCM practitioner performs it.
2. 24/7 access to a care team member for urgent needs, and the ability to schedule successive routine appointments with a designated team member.
3. Comprehensive care management, including needs assessments, preventive service systems and medication reconciliation.
4. An electronic patient centered care plan, shared within and outside the practice, with a copy given to the patient or caregiver.
5. Care transition coordination, including follow up within 7 days of discharge from an ED visit, hospital or skilled nursing facility, as clinically indicated.
6. Coordination with home and community based providers.
7. Enhanced communication options, such as secure messaging, e visits and interprofessional consults.
8. Population level management that finds care gaps and groups patients by risk.
9. Measuring and reporting performance, through the Primary Care MIPS Value Pathway or participation in an ACO or another listed model.

Clinical staff can deliver APCM services incident to the billing practitioner's work under general supervision, per CMS. They can be employees, leased employees or independent contractors, as long as they meet state and Medicare requirements.

Can you bill APCM with CCM, PCM or TCM?

Not for the same patient from the practitioner who bills APCM. CMS designed APCM as a bundle that already includes elements of those services, so they're treated as duplicative in a month when APCM is billed. Our same month billing guide lays out the full matrix.

The exception CMS built in is behavioral health. The G0568 and G0569 add on codes cover psychiatric collaborative care, and G0570 covers general behavioral health integration. You bill them only in the same month as an APCM base code, by the same practitioner, and they don't have time requirements.

If you're weighing the two models, our explainer on why APCM and CCM can't be billed together covers when each one fits better. In short, time based CCM can pay more for a patient who needs a lot of documented staff time, and APCM is simpler when you want a flat monthly bundle across a panel.

Why has APCM reached so few patients?

Awareness and cost sharing are the two biggest reasons, and the data is recent enough that you can see both. Adoption grew 2.7 fold from the first to the fourth quarter of 2025, but it still touched only 1.2% of fee for service beneficiaries.

The PCC analysis found that 63% of the volume growth came from clinicians who weren't billing in the first quarter. It also found that 12% to 16% of billing clinicians stopped from one quarter to the next. The authors said the limited claims history makes that turnover hard to explain.

Cost sharing is the barrier practices raise most. About 13% of Original Medicare beneficiaries have no supplemental coverage, so they owe coinsurance every month, and QMBs owe nothing. In the PCC's summer 2026 survey, 42% of respondents ranked collecting the copay as the biggest implementation hurdle, and 54% said waiving it for people without supplemental coverage would help most.

The survey of 404 clinicians pointed to a different problem. Among non users with a specific barrier, 53.0% said they didn't understand the documentation required and 38.1% cited EHR issues. None of this is a verdict on whether APCM pays off for a given practice. The published data describes uptake and barriers, not outcomes or savings, and the PCC itself calls the savings question unanswered.

What this means for your practice

Start with your panel, not the codes. Count the Medicare patients you're already the primary care home for, split them into the three levels, and check how many are QMBs. Then decide how you'll handle consent and the monthly copay conversation, because that's where adoption stalls.

Next, map each required element to a person and a workflow. The elements most practices have to build are the shared care plan, the 7 day post discharge follow up, and the population level gap reports. Write down who does each one, and keep the evidence in the chart.

Then decide which care management program fits which patient. A patient with heavy monthly needs may fit time based CCM better, and a panel wide approach may fit APCM. Read our CCM guide and the CCM dropout article before you pick, since retention affects either program's revenue.

At HANA, we build the outreach and follow up side of care management for practices, which you can read about on our remote care management page.

Frequently asked questions

Do I need to document time to bill APCM?

No. APCM isn't time based, and CMS doesn't require a time log. You still need to document consent, the care plan and the services you furnished that month, because the code descriptor requires you to meet the requirements.

Can a patient be billed the copay for APCM?

Generally yes. Part B coinsurance of 20% applies, so a patient without supplemental coverage owes a monthly amount. QMBs can't be billed Medicare cost sharing. CMS requires you to tell the patient about the copay when you get consent.

Does an Annual Wellness Visit count as the initiating visit?

It can. CMS says the AWV may serve as the initiating visit if the practitioner responsible for APCM performs it. A new patient, or one not seen in three years, needs an initiating visit before you start billing.

Can nurses and medical assistants deliver APCM?

Auxiliary personnel can deliver APCM incident to the billing practitioner's professional services under general supervision. State licensure rules and Medicare exclusion checks still apply, so confirm both before you assign tasks.

What changed for APCM in 2026?

CMS added the optional add on codes G0568, G0569 and G0570 for collaborative care and behavioral health integration, billed with an APCM base code in the same month. The base code payments also moved with the 2026 fee schedule update.

Sources

1. Centers for Medicare and Medicaid Services, Advanced Primary Care Management Services, accessed November 2026.
2. Centers for Medicare and Medicaid Services, MLN Matters MM14315: Medicare Physician Fee Schedule Final Rule Summary CY 2026, December 2025.
3. Federal Register, CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies, November 5, 2025.
4. Weida T and Weida J, American Academy of Family Physicians, Implementing Advanced Primary Care Management: A Practical Guide, Family Practice Management, September 2026.
5. Primary Care Collaborative and West Health Policy Center, APCM: Ensuring the Bundled Payment Delivers Better Health, October 2026.
6. Grumbach K and colleagues, Primary Care Clinician Uptake of Medicare Advanced Primary Care Management Billing Codes, Journal of General Internal Medicine, October 2026.
7. Payerchin R, Medical Economics, First look at APCM data: Growth, modest reach, physician turnover for Medicare's primary care bundle, November 3, 2026.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill.

If you want to talk through how this fits your practice, book a discovery call with HANA.