Advanced Primary Care Management
What it is
Advanced Primary Care Management (APCM) (G0556 / G0557 / G0558, since CY 2025) is a monthly Medicare Part B service furnished by clinical staff under the general supervision of the practitioner who is responsible for the patient's primary care and the continuing focal point for all needed care.
APCM is billed per patient per calendar month at one of three levels. It is not time-based: no minute threshold, and not every service element has to be furnished every month. By billing APCM the practice attests to the practice-level capabilities in the descriptor: 24/7 access and continuity of care, enhanced communication, population-level management and performance measurement.
Who qualifies
- The billing practitioner intends to be the patient's primary-care practitioner and continuing focal point. CMS sets no specialty for APCM; the billing practitioner records that determination at enrollment.
- Initiating visit — new patients only (not seen by the practice within 3 years): a qualifying visit with the billing practitioner.
- Consent to receive APCM from that practitioner, documented before APCM starts and given once; a new consent if the practitioner changes. A month bills only on a consent that covered it.
- One practitioner can furnish and be paid for APCM per patient per month.
- Not in the same month by the same practitioner (CMS Table 26): CCM, PCM, TCM, e-visits, virtual check-ins, remote evaluations, interprofessional consults. willowbridge policy (CMS does not require this): APCM and CCM are never both billed for a patient in the same month, by any practitioner, and G2010, G2012 and 98016 also stop the month. A practice can enroll a patient in both APCM and CCM and bill one of them each month by a fixed rule (willowbridge's dual-enrollment setting; CMS does not address alternating between them).
- The level (L1 / L2 / L3) follows the qualifying chronic-condition count on the care plan signed for the month and a QMB verification covering the month; it is worked out every month, not fixed at enrollment.
Codes & when to bill them
Each billable code, with the requirements that must be on file to bill it.
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G0556APCM Level 1 — one chronic condition or fewer (none is fine).RequirementsConsent covering the month; the care plan signed for the month with an active goal; the practice-level capabilities, attested by billing. No minimum time and no required monthly contact.
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G0557APCM Level 2 — two or more chronic conditions.RequirementsAs G0556, plus two or more qualifying chronic conditions on the care plan signed for the month; the billing practitioner attests at sign-off that each meets the CMS definition (12 months or until death, significant risk).
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G0558APCM Level 3 — two or more chronic conditions AND Qualified Medicare Beneficiary (QMB) status, verified.RequirementsAs G0557, plus QMB status (QMB-only or QMB-Plus; never a Part B-ID QMB) verified against HETS 270/271, the Medicare remittance advice (N781/N782) or the State Medicaid eligibility system, with the date, source and group recorded, covering the month.
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G0570APCM behavioral-health add-on for general BHI, in place of 99484, with no minute threshold.RequirementsOnly with the same practitioner's G0556–G0558 for the month; behavioral diagnosis, goal and a rating scale in the month; never in the same month as 99484. Signed after the APCM month, on the patient's BHI month.
Documentation required every cycle
Each calendar month must show:
- The consent the month rests on — its wording, date, how it was captured, and the practitioner it names.
- Level basis — the qualifying chronic conditions on the care plan signed for the month, and for Level 3 a dated, sourced QMB verification (HETS 270/271, the Medicare remittance advice (N781/N782) or the State Medicaid eligibility system) with its eligibility group, covering the month.
- The care plan signed for the month, with an active goal and a coded problem for the claim, available to the care team, with a copy to the patient.
- The actions recorded in the month, each dated, with who did it and the service element it furnishes. None are required; a month with none says so.
- Practice-level records — the population-level review for the month (willowbridge policy), the practitioner's performance-measurement pathway for the year, and the after-hours instructions.
What's new in CY 2026
CY 2026 adds the behavioral-health add-ons G0568–G0570, billable only alongside the same practitioner's APCM claim for the month and never in the same month as 99484 / 99492–99494. willowbridge bills the add-on on the patient's BHI month, signed after the APCM month. Date of service: the month's last day (willowbridge convention; CMS sets none).
Built-in patient consentwillowbridge exclusive
Every program ships with compliant, CY-2026 patient consent language — read verbatim into the in-app consent capture flow, captured with date + modality, and version-pinned to each claim, so the consent on file always matches the consent that was billed. No more chasing signatures or re-papering when the rule changes.
Common questions
Who qualifies for Advanced Primary Care Management (APCM)?
The billing practitioner intends to be the patient's primary-care practitioner and continuing focal point. CMS sets no specialty for APCM; the billing practitioner records that determination at enrollment. Initiating visit — new patients only (not seen by the practice within 3 years): a qualifying visit with the billing practitioner. Consent to receive APCM from that practitioner, documented before APCM starts and given once; a new consent if the practitioner changes. A month bills only on a consent that covered it. One practitioner can furnish and be paid for APCM per patient per month. Not in the same month by the same practitioner (CMS Table 26): CCM, PCM, TCM, e-visits, virtual check-ins, remote evaluations, interprofessional consults. willowbridge policy (CMS does not require this): APCM and CCM are never both billed for a patient in the same month, by any practitioner, and G2010, G2012 and 98016 also stop the month. A practice can enroll a patient in both APCM and CCM and bill one of them each month by a fixed rule (willowbridge's dual-enrollment setting; CMS does not address alternating between them). The level (L1 / L2 / L3) follows the qualifying chronic-condition count on the care plan signed for the month and a QMB verification covering the month; it is worked out every month, not fixed at enrollment.
Which codes does willowbridge bill for APCM, and when?
APCM is a flat monthly fee by patient level — there are no minute tiers and no required monthly contact. Each month bills one of three levels from the care plan signed for that month and a QMB check covering it: G0556 (Level 1, one or no qualifying chronic condition — none is fine), G0557 (Level 2, two or more), or G0558 (Level 3, two or more plus Qualified Medicare Beneficiary status — the QMB-only or QMB-Plus group, verified for the month). The level picked at enrollment never sets the code. A month with no patient-specific action still bills: the practice-level capabilities are attested by billing, and the note says so. A missing piece — the consent, the signed plan, the practice's population review — holds the month with words until it is recorded. When the same practitioner bills a patient's APCM and BHI, the BHI month bills as the behavioral-health add-on, signed after the APCM month: G0570 for general BHI, G0568 / G0569 for Collaborative Care.
What changed for APCM in CY 2026?
CY 2026 adds the behavioral-health add-ons G0568–G0570, billable only alongside the same practitioner's APCM claim for the month and never in the same month as 99484 / 99492–99494. willowbridge bills the add-on on the patient's BHI month, signed after the APCM month. Date of service: the month's last day (willowbridge convention; CMS sets none).
Related programs
See every program working together in A month in the life, our case study in real willowbridge screens.