In 2025, Medicare introduced three new Advanced Primary Care Management (APCM) codes —G0556, G0557, and G0558 — to support streamlined, comprehensive care for patients with chronic conditions. These codes not only simplify billing but are also tied to performance reporting under the Merit-based Incentive Payment System (MIPS). This post breaks down what providers need to know. 

What are the APCM codes? 

• G0556: For patients with 1 chronic condition (~$15/month) 

• G0557: For patients with 2 or more chronic conditions (~$50/month) 

• G0558: For Qualified Medicare Beneficiaries (QMBs) with 2 or more chronic conditions and additional social risk factors (~$110/month) 

Unlike previous care management codes, APCM codes bundle services such as care planning, care transitions, and communication efforts without requiring time-based documentation. They don't, however, appear in any CQM measure definitions. 

Who can bill APCM codes?

Eligible providers include: 

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

• Non-physician practitioners (NPs, PAs, CNMs, clinical nurse specialists) providing primary care 

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

Restrictions 

• Must deliver comprehensive, continuous primary care 

• Only 1 provider can bill per patient per month 

• Specialists generally excluded unless they meet primary care coordination criteria 

Why MIPS MVP reporting matters

Providers billing APCM codes must report the Value in Primary Care MIPS Value Pathway (MVP) starting in the 2025 performance year (impacting payments in 2027). 

MVP requirements include: 

• Quality measures 

• Improvement activities 

• Interoperability reporting 

• Population health metrics 

Consequences of not reporting MVP 

• Claim denials: CMS may deny payment for G0556, G0557, and G0558 without proper MVP reporting.

• MIPS penalties: Up to a minus-9% adjustment on all Medicare Part B claims for failure to report.

Exceptions 

• RHCs and FQHCs are exempt from MVP reporting.

• ACO participants may meet requirements through ACO-level reporting.

Key compliance Requirements

To avoid denials or penalties:

1. Report MVP annually beginning in 2025
2. Maintain patient consent and care documentation
3. Ensure only one practitioner bills APCM codes monthly per patient 
   

Compared to Chronic Care Management (CCM) codes, APCM codes: 

• Eliminate time-based billing 

• Stratify payment by patient complexity 
  

• Bundle more comprehensive services 

• Promote multidisciplinary care coordination 

• Simplify compliance, especially for ACOs and value-based care participants 

Takeaway for practices

APCM codes offer a simplified, flexible model for chronic care management, but they come with compliance responsibilities tied to MVP reporting. Practices should prepare workflows and documentation systems now to ensure proper billing and to avoid potential penalties. 

For more updates on MIPS, MVPs, and primary care strategy, reach out to us for more information. 

Learn more about MVPs 

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