Advanced Primary Care Management (APCM) is a new healthcare model introduced by the Centers for Medicare & Medicaid Services (CMS) to strengthen primary care services. Outlined in the Calendar Year 2025 Physician Fee Schedule (PFS), APCM focuses on strengthening the primary care system to improve patient outcomes and address care gaps. This approach supports healthcare providers in the transition toward value-based care. APCM integrates services such as Principal Care Management (PCM) and Transitional Care Management (TCM).
This guide explains APCM, billing requirements, billing codes, and how providers can integrate remote monitoring to support preventive care and patient engagement, and reduce overall healthcare costs.
Advanced Primary Care Management Reimbursement
Healthcare providers using Advanced Primary Care Management should be able to offer a set of 13 service elements outlined by CMS. Not all are required each month. However, a patient does have to consent to APCM.
Advanced Primary Care Management billing is not time-based. Primary care providers can bill for care management services without meeting CCM’s 20- or 30-minute time thresholds.
- Level 1 — G0556: For patients with one chronic condition (or none), meeting specific service requirements. $15
- Level 2 — G0557: For patients with two or more chronic conditions, meeting specific service requirements. $50
- Level 3 — G0558: For Qualified Medicare Beneficiary (QMB) patients with two or more chronic conditions. $110
APCM services cannot be billed with CCM, PCM, or TCM services. However, remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) services can be billed separately. This means practices can receive reimbursement for RPM and RTM services alongside APCM. This flexibility allows providers to customize care delivery, and offer RPM where appropriate.
How APCM and RPM Work Together
While Advanced Primary Care Management focuses on comprehensive care coordination, RPM’s real-time health data supports timely interventions. Providers can monitor and communicate with patients remotely and identify health risks between in-person visits.
Below are examples of how APCM and RPM work together to optimize patient management and reimbursement strategies.
- Continuous Patient Monitoring: Providers can use RPM and RTM devices to track vital signs, medication adherence, and disease progression, ensuring timely interventions.
- Data-Driven Care Coordination: APCM’s population health approach allows providers to analyze RPM data for early detection of health risks and adjust care plans proactively.
- Reduced Hospitalizations: With RPM and RTM alongside APCM, providers can prevent hospital admissions and readmissions through remote intervention.
- Seamless Reimbursement: While APCM supports value-based care, RPM remains separately billable, offering an additional revenue stream using both models.
Implementing APCM with RPM
Implementing an RPM program with the Advanced Primary Care Management model requires a strategic approach. Below are key steps to ensure a seamless and efficient integration of RPM within the APCM framework.
- Invest in Reliable Technology: Utilize user-friendly devices that accurately capture and transmit patient data.
- Train Care Teams: Ensure that healthcare professionals are proficient in using RPM tools and interpreting the data collected.
- Develop Clear Protocols: Establish guidelines for monitoring, data analysis, and patient communication to ensure timely and appropriate responses to health data.
By combining APCM with RPM, healthcare providers can offer a more dynamic and responsive care experience, ultimately leading to improved patient outcomes and a more efficient healthcare delivery system.
Understanding Advanced Primary Care Management
Advanced Primary Care Management enables a shift toward proactive, data-driven care. By integrating remote monitoring with APCM, primary care providers can enhance patient outcomes, optimize workflows, and improve reimbursement efficiency. As primary care moves toward value-based models, the combination of APCM and remote monitoring offers a scalable approach to delivering high-quality, technology-enabled patient care.
