What is APCM?

APCM is a Medicare care management service that reimburses providers for delivering advanced primary care coordination, particularly for patients with multiple chronic conditions. The program focuses on:

• Building and maintaining comprehensive, patient-centered care plans

• Coordinating across specialties and community services

• Ensuring continuity of care outside the office setting

Which CPT/HCPCS codes apply to APCM?

The primary codes for APCM include:

• G0556 – Comprehensive care plan development for patients with multiple chronic conditions (60 minutes of physician/QHP time per calendar month)

• G0557 – Each additional 30 minutes of physician/QHP time

• G0558 – Each additional 30 minutes of clinical staff time under supervision

How is APCM different from CCM?

• CCM (99490 series): Focuses on monthly non-face-to-face management of two or more chronic conditions. Often furnished by clinical staff.

• APCM (G0556 series): Requires direct physician or QHP involvement in developing, revising, and implementing complex care plans. Time thresholds are higher, and documentation must reflect higher complexity.

Who is eligible for APCM?

Patients must have:

• Two or more chronic conditions expected to last at least 12 months or until death

• Conditions that place them at significant risk of decline, decompensation, or death

• A need for comprehensive care plan development or revision requiring physician/QHP oversight

What documentation is required for APCM?

• Comprehensive care plan (diagnoses, goals, interventions, responsible clinicians, community resources)

• Time logs documenting minutes spent by physician/QHP or clinical staff

• Patient consent (verbal or written) documented in the record

• Evidence of care coordination with other providers and services

Can APCM be billed with CCM or PCM?

• Not concurrently for the same patient in the same month.
  CMS prohibits double billing when services overlap in scope and time.

• Practices may alternate APCM and CCM in different months if justified by patient needs.

What is the reimbursement potential?

• G0556 reimburses at a higher rate than CCM codes due to physician/QHP involvement.

• Add-on codes G0557 and G0558 increase reimbursement for additional time.
  Exact payment varies by region and payer, but APCM typically pays more than standard CCM.

What are common compliance pitfalls?

• Insufficient documentation of physician/QHP time – CMS requires detailed notes.

• Failure to update care plans – APCM requires active development/revision, not passive review.

• Overlapping billing with CCM or PCM – Must ensure services are distinct by month.

• Missing patient consent – Must be documented before initiating services.

Which patients should be prioritized?

• Patients with multiple, unstable chronic conditions (e.g., CHF + CKD + diabetes)

• Those recently discharged from the hospital with complex care needs

• Seniors with frequent medication changes or polypharmacy

• Patients requiring frequent coordination among multiple specialists

Key Takeaways

• APCM is designed for patients needing comprehensive, physician-led care planning.

• Codes G0556–G0558 support billing for time-intensive coordination and documentation.

• Practices must prioritize time tracking, consent, and clear care plan documentation.

• APCM should be considered for high-risk patients where CCM alone may be insufficient.