What primary care providers must know about billing, compliance, and MIPS MVPs in 2025

In 2025, CMS launched a significant evolution in its commitment to primary care: the Advanced Primary Care Management (APCM) codes. These codes — G0556, G0557, and G0558 — are designed to simplify billing, support patient-centered care, and advance health equity for patients with chronic conditions. 

But there’s a catch. These codes come with new requirements, including participation in the Value in Primary Care MIPS Value Pathway (MVP) for eligible clinicians. 

In this post, we’ll break down: 

• What APCM codes are 

• Who can bill them 

• How they differ from existing care management codes 

• What’s required for MIPS compliance 

• What happens if you don’t report 

• What steps your practice should take next 

What are the 2025 APCM codes? 

The new G-codes introduced in the 2025 Medicare Physician Fee Schedule are monthly billing codes that bundle multiple care-management services under 1 simplified payment model: 

These services are based on a 13-element care management model that includes initiating visits, 24/7 access to care, population health, risk stratification, care planning, and care coordination. Importantly, there is no time-based documentation threshold, unlike CCM codes that require specific minutes of care. 

Who can bill APCM codes? 

Billing eligibility is intentionally narrow to support continuity and accountability in primary care. Providers must be one of the following: 

• Primary care physicians (family medicine, internal medicine, geriatrics, pediatrics) 

• Qualified non-physician practitioners (NPPs) such as: 

• • Nurse practitioners 

• • Physician assistants 

• • Certified nurse midwives 

• • Clinical nurse specialists 

• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) 

Providers must also meet all of these requirements: 

• Serve as the continuing focal point for all of a patient’s healthcare needs 

• Provide or coordinate all primary-care services 

• Supervise the care team (services may be delivered under general supervision) 

• Be the only provider per patient per month to bill APCM codes 

• Maintain documentation including patient consent, care plans, and service elements 

Providers outside of these requirements, or those specializing in episodic or consultative care, aren’t eligible to bill these codes. 

How APCM codes compare to CCM and other care management services 

APCM codes are more flexible, holistic, and aligned with value-based care models than existing time-based care management codes. 

Value in Primary Care MVP 

Starting with the 2025 performance year, MIPS-eligible clinicians who bill APCM codes must report the Value in Primary Care MVP to remain compliant and receive payment. 

What’s in the MVP? 

The MVP includes 4 categories: 

1. Quality measures
   • • • • • • • • • • • • • • • • Aligned with prevention, chronic disease, and care continuity 
                                 • Examples:  
                                   1. 1. 1. 1. Diabetes: HbA1c Poor Control
                                            2. Depression Screening
                                            3. Promoting Interoperability (PI)
2. Promoting Interoperability (PI)
   • • • • • • • • • • • • • • • • • Patient portal access, e-prescribing, clinical information exchange
3. Improvement Activites
   • • • • • • • • • • • • • • • • • Activities like care coordination, health coaching, and team-based care
4. Population Health measures
   • • • • • • • • • • • • • • • • Screening and follow-up for social drivers of health Clinicians must use a qualified registry, QCDR, or EHR system to submit these measures. 

What happens if you don’t report the MVP? 

If providers bill G0556, G0557, or G0558 but don’t report the MVP, they face 2 major consequences: 

1. Claim denials
   • • • • • • • • • • • • • • CMS will deny APCM claims if performance measurement requirements tied to MVP reporting aren't met. 

2. MIPS payment penalties
   • • • • • • • • • • • • • • Eligible clinicians may face up to a 9% payment reduction across all Medicare Part B claims — not just the APCM codes. These penalties apply 2 years after the performance year, meaning failure in 2025 affects 2027 payments. 

Who Is exempt from MVP reporting? 

• • • • • • • • • • • • • • • • • • • • • RHCs and FQHCs: These entities can bill APCM codes but are exempt from MVP reporting. 
                                        • ACO participants: Practices in an Accountable Care Organization may meet MVP-equivalent reporting via their ACO’s quality reporting system. 
                                        • Non-MIPS clinicians: Those below low-volume thresholds or otherwise ineligible for MIPS aren’t required to report. 

What practices should do now 

To prepare for successful APCM billing and MVP compliance, practices should 

1. Evaluate eligibility: Ensure your providers meet the specialty and care coordination criteria for APCM billing.
2. Integrate the 13 service elements: Implement workflows to deliver and document the APCM service components:

• • • • • • • • • • • • • • • • • • Patient consent and initiating visits 
                                  • 24/7 access 
                                  • Risk stratification 
                                  • Population health interventions 
                                  • Care plan development 
                                  • Digital communications and follow-ups 

3. Align MVP reporting workflows: 

• • • • • • • • • • • • • • • • • Review the Value in Primary Care MVP specifications 
                                • Identify the required quality and PI measures 
                                • Align documentation in your EHR or registry platform 
                                • Educate staff on new documentation expectations 

4. Monitor claim submission and denials: Track billing activity and denials closely. Use revenue cycle data to ensure compliance and maximize reimbursement.

Final thoughts 

The APCM codes are more than just billing updates. They reflect Medicare’s evolving expectations for team-based, continuous, and equitable primary care. For practices already striving to deliver high-quality chronic care management, these codes offer the chance to be paid more fairly and consistently — but only if the practice meets its MIPS MVP obligations. 

As CMS continues to shift the Medicare payment model toward value and outcomes, integrating billing, quality reporting, and care delivery is no longer optional. It’s essential. 

Need help mapping your providers to the right MVP or optimizing your documentation and workflows? Reach out to our team at info@healthmonix.com. We’d love to help. 

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