Advanced Primary Care Management
A bundle that pays for being available.
One bundled payment a month, no minute threshold, and thirteen service elements that have to be available.
Your team reviews. Your provider signs.
Eligibility
Who qualifies for APCM.
One bundled payment a month, no minute threshold, and thirteen service elements that have to be available.
Advanced Primary Care ManagementG0556 · G0557 · G0558
The patient
Three levels: one condition or fewer, two or more, and two or more for Qualified Medicare Beneficiaries.
If that does not describe your patient, nothing below applies.
The month
No time threshold at all. One bundled payment a month, with thirteen service elements that have to be available to the patient.
Read it one patient at a time, exactly as it is written above.
Consent and the initiating visit
Consent and the initiating visit are part of what this program leaves in the record.
How consent is taken and recorded, and whether a visit has to come first, are not settled on this page. We will not print a rule we cannot source. Ask us before you enroll anyone.
One more rule
The practitioner billing APCM cannot also bill CCM, PCM or TCM for that patient in the same month, though a different practitioner can. Practices billing it report the Value in Primary Care MVP from 2026.
Not sure whether your patients count? Talk to us and we will go through your panel with you.
Programs are what your practice bills. HANA does not bill, and its call time is never counted as clinical time. Requirements here are the Medicare rules as they stand in October 2026 and are worth checking against your MAC before you rely on them.
What it pays
What APCM pays.
One base code, one patient, one month. National, before adjustment. Not what you collect.
$53.78
One bundled payment a month, with no time threshold, for thirteen service elements that have to be available to the patient.
Medicare pays
$43.02
Patient owes
$10.76
Part B coinsurance. A known enrollment obstacle.
The code family
What else the same patient's month can carry. Same basis as the figure.
- G0557The base code on this page.$53.78
- G0556Level 1, for a patient with no chronic condition or one.$16.37
- G0558Level 3, for two or more chronic conditions when the patient is a Qualified Medicare Beneficiary.$117.24
The practitioner billing APCM cannot also bill CCM, PCM or TCM for that patient in the same month, though a different practitioner can. Practices billing it report the Value in Primary Care MVP from 2026.
APCM · Who does what
HANA does the volume. Your team does the deciding.
HANA does the reaching out and the writing up. Every clinical judgement stays with your people, and nothing bills until a person on your team approves it.
HANA does
The work that repeats
- Answers the elements that are pure reach: ongoing communication, the monthly contact, the follow-up after a transition.
- Runs across the whole panel every month, including the patients nobody had minutes left for.
- Logs and attributes every contact, so an element being available is documented rather than asserted.
Your team does
Never delegated
Owns the care plan, the round-the-clock access and every clinical judgement. HANA is the capacity behind the elements.
Your team reviews, your provider signs.
What the month leaves in the record
- Monthly contact record
- Consent and initiating-visit trail
The record is built while the work happens, not afterwards.
How it works
Forty-five minutes a patient.
We take it under thirty.
One coordinator. Same hours. Two hundred and fifty patients instead of a hundred and fifty.
Hana calls · you set the protocol
It calls from your number until someone picks up. Then medications, symptoms, and what changed.
Hana routes · your team decides
Anything clinical goes to your team, with the reason and the transcript attached.
Your clinician reviews · Hana writes
The note is in the chart before your team opens it. Under that patient, not in a spreadsheet.
You submit · Hana supplies the evidence
Every minute attributed to the person who earned it, ready to attest on the first.
You set the escalation rules. A person on every clinical flag, an audit trail on every call, minutes totalled per patient.
45-60min
per patient, per month, today
What a coordinator spends on one enrolled patient when the calling, the chasing and the note are all done by hand.
120-160
the caseload that caps at
Which is why most programs stall well short of what the panel could support.
29min
what HANA is built for
Same coordinator, same hours, toward 250 patients. HANA makes the calls; your team reviews and attests.
Your team reviews it. Your provider signs it. Nothing is billed until a person on your team approves it.
The month is written up before you start your time.
Every contact HANA makes is recorded and summarised straight into the patient's record. When your clinician opens the patient, the month is already there, and the time they log is their own: reviewing, acting on what HANA flagged, and attesting. Not typing.
0:00
Time your team spends writing the month up
4
Documented contacts waiting when they open the chart
Time log · an example month
APCM G0557Reached on the second attempt. Symptoms stable, questions answered.
HANA call · summarised
Medication taken as planned. One new concern noted for the clinician.
HANA call · summarised
Reported change against the threshold your clinicians set. Escalated live.
HANA call · flagged to the threshold you set
Plan reconfirmed. Time attributed, note in the chart, waiting for review.
HANA call · summarised
Your clinician's time
Review and attest
2:52
Program math
The rate is set. The enrollment is not.
Medicare sets the rate. You set how much of your eligible panel is on the program, and that is where the whole figure comes from.
One program, one month
What a month of this program comes to
Set the panel and the enrollment. The rate is the multiplier and it sits still.
$538
estimated, per month
10 of 250 eligible patients enrolled on APCM. G0557, CY2026 rate.
Eligibility is yours to count. APCM asks for this: Two or more chronic conditions. Level 2 of three. The marks are starting points, not claims about your panel.
How the figure is built
10 enrolled patients on APCM G0557, at $53.78 each, comes to $538 a month.
$53.78
per enrolled patient, per month · Advanced Primary Care Management · G0556 · G0557 · G0558
The arithmetic
250 eligible patients4% enrolled10 on the program
10 on the program$53.78 per patient, per month$538 a month
What the code pays for. One bundled payment a month, with no time threshold, for thirteen service elements that have to be available to the patient.
G0557, national non-facility, Medicare PFS CY2026.
The 4% default: in 2019, that share of eligible Medicare fee-for-service patients was actually enrolled. Enrollment has grown since, so read it as a floor. Source: Colligan E et al., “Analysis of 2019 Medicare Fee-for-Service Claims for Chronic Care Management and Transitional Care Management Services”, NORC at the University of Chicago for HHS ASPE, March 2022..
An estimate, not a quote and not billing advice. One base code per enrolled patient per month, before add-on codes, geography, sequestration and the patient's share, and it assumes every enrolled patient bills every month, which no real month does. Check it against your MAC.
Have a chat with HANA.
Give us your number. It calls in about ten seconds. Talk to it like a patient would, then let your team try it.
Hear Hana handle a real patient conversation.
Enter your details. Hana texts you to confirm, then calls within seconds, so you can hear it for yourself.
Questions practices ask
Before you start.
CCM pays for twenty minutes of clinical staff time in a month. APCM has no time threshold at all: it is one bundled payment against thirteen service elements that have to be available to the patient. You are not counting minutes, you are demonstrating availability.
The level is set by how many chronic conditions the patient has, not by time. G0556 is for none or one ($16.37), G0557 for two or more ($53.78), and G0558 for two or more when the patient is a Qualified Medicare Beneficiary ($117.24). Those are CY2026 national non-facility amounts, before adjustment. This page models the middle level.
No time threshold at all. One bundled payment a month, with thirteen service elements that have to be available to the patient.
Owns the care plan, the round-the-clock access and every clinical judgement. HANA is the capacity behind the elements. HANA makes the calls and writes them up. Nothing bills until a person on your team approves it.
G0557 is CY2026 $53.78 national non-facility, before geographic adjustment. That is the middle of three levels, for one patient in one calendar month. It is not what the practice collects: sequestration and the standard Part B patient coinsurance both come off, and the amount varies by locality.
The practitioner billing APCM cannot also bill CCM, PCM or TCM for that patient in the same month, though a different practitioner can. Behavioral health integration and collaborative care can run alongside it, and since 2026 they have add-on codes for that (G0568 to G0570), billed without counting minutes. Practices billing APCM report the Value in Primary Care MVP from 2026.
Not every element every month. CMS expects the practice to be able to deliver all of them in any month, to record in the chart whatever it actually does for the patient, and treats billing APCM as attesting that those capabilities are in place. HANA's record covers the contacts it makes. The practice-level capabilities, like round-the-clock access and the electronic care plan, are yours.
Verbally or in writing, once, at the start, and documented in the record. The patient is told that the service is available, that only one practitioner can bill it in a month, that they can stop at any time, and that cost sharing may apply. A patient moving over from chronic care management needs a new consent, and so does one who changes practitioner.
Only a new patient, meaning someone who has had no professional service from the practitioner or anyone in their group in the past three years. For them, APCM starts at a level 2 to 5 office visit, an annual wellness visit, an initial preventive physical exam or a TCM visit where APCM is discussed, by the practitioner who will bill it.
A physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife who is responsible for the patient's primary care, and only one of them per patient per month. Staff work under general supervision, and there are no minutes to count: CMS says APCM is not time based.
As proposed in July 2026, nothing in APCM's codes or requirements. CMS did say first-year uptake was lower than it expected and asked for comments on how the payment is structured, so this is one to re-check when the final rule lands, expected around November 2026.
Yes. FQHCs and RHCs bill G0556 to G0558 at the national non-facility rate, on top of their visit payment and with or without a visit that day.
Ready when you are
Hear it make the call. Then decide.
Bring your panel numbers. We will go through which programmes your patients already qualify for, and what your team would still do.
- Your patients, your claim
- Your team reviews and attests
- Nothing bills until a person approves