APCM Software & Program Support
Advanced Primary Care Management Software and Program Support
HealthArc helps physician practices launch, operate and bill CMS-compliant Advanced Primary Care Management programs: software, care coordination tools and expert support built for the APCM framework.
APCM replaces time-tracked CCM and PCM billing with a non-time-based model using HCPCS codes G0556, G0557 and G0558. HealthArc automates patient stratification, care plan documentation, consent tracking and the monthly billing cycle.
HIPAA Compliant
AICPA SOC 2 Type II
BAA available
Primary care, geriatrics, FQHCs & RHCs
No time trackingbilled per patient, per month
APCM HCPCS tiersEffective Jan 1, 2025
G0556Level 1: one chronic condition~$10
G0557Level 2: two or more conditions~$50
G0558Level 3: QMB with two or more~$110
Time logsNot required to bill APCM–
3HCPCS codes, one monthly claim
0 mintime tracking required
2–4 wkstypical time to go live
4legacy programs consolidated
Program Overview
What Is Advanced Primary Care Management (APCM)?
Advanced Primary Care Management (APCM) is a CMS care management initiative that took effect on January 1, 2025. It consolidates several existing Medicare services: Chronic Care Management, Principal Care Management, Transitional Care Management and communication technology-based services into a single, unified billing framework.
Unlike CCM and PCM, which require clinical staff to track time, APCM uses non-time-based billing. Providers bill on the basis of patient risk stratification level and are reimbursed monthly per qualifying beneficiary.
APCM is billed with three HCPCS codes: G0556 for patients with one chronic condition, G0557 for patients with two or more chronic conditions of at least 12 months’ duration, and G0558 for Qualified Medicare Beneficiaries with two or more such conditions. Monthly rates are approximately $10, $50 and $110 per patient respectively, and vary by geographic locality.
To qualify, patients must provide documented consent, have a current comprehensive care plan on file and have been seen by the billing provider within the required window: 36 months for G0556, 12 months for G0557 and G0558. Services must be furnished by a qualified physician or non-physician practitioner and billed under Medicare Part B.
APCM full form
Advanced Primary Care Management: a CMS initiative under Medicare Part B
Effective
January 1, 2025, introduced in the CY 2025 Physician Fee Schedule
Billing model
Non-time-based: one monthly code per patient by risk tier
HCPCS codes
G0556 · G0557 · G0558: see the full APCM code reference
Consolidates
CCM, PCM, TCM and communication technology-based services
Requirements
Documented consent, current comprehensive care plan, qualifying recent visit
Why practices migrate. The administrative cost of CCM was never the care. It was proving the minutes. APCM removes the stopwatch and replaces it with a risk tier and a documentation standard, which is a far easier thing to automate and a far harder thing to get wrong at audit. HealthArc runs both models, so a practice can migrate tier by tier rather than all at once.
Who It’s For
Who Is APCM For?
HealthArc’s APCM software and services are built for Medicare-participating practices that want to improve chronic care outcomes while capturing the reimbursement APCM makes available.
By Specialty & Practice Type
- Primary care: family medicine, internal medicine, general practice
- Geriatric medicine practices with high-risk elderly Medicare panels
- FQHCs and Rural Health Clinics (RHCs)
- Multi-provider groups and ACO-affiliated primary care teams
- Hospital-affiliated outpatient clinics managing post-discharge Medicare patients
- Concierge and direct primary care practices adding structured care management
By Patient Population
- Medicare Part B beneficiaries with one or more chronic conditions
- Dual-eligible and QMB patients: eligible for the higher G0558 tier
- High-risk patients with diabetes, CHF, COPD, CKD and hypertension
- Patients recently discharged from inpatient or post-acute care
By Organisational Readiness
- Practices billing CCM or PCM that want APCM’s simplified model
- Practices with no care management program that want to start with APCM
- Health systems standardising care management across multiple locations
- Groups building toward value-based contracts
The Qualification Test
A patient qualifies for APCM in a given month when all of the following hold:
- The patient is a Medicare Part B beneficiary attributed to your billing provider
- Documented consent to the APCM program is on file
- A current comprehensive care plan exists and is maintained
- The patient was seen by the billing provider within the required window: 36 months for G0556, 12 months for G0557 and G0558
- Only one provider bills APCM for that patient in that month
If your practice sees a Medicare patient population with chronic conditions and bills under Part B, APCM is almost certainly a billable and operationally viable program for you. The question is usually which tier each patient lands in, which is what HealthArc’s stratification engine answers before the billing cycle opens.
The Platform
APCM Software Features Built for Primary Care Operations
HealthArc’s APCM platform is purpose-built for the operational realities of primary care. It was not adapted from a generic care management tool. Every feature maps to a CMS APCM requirement or a daily workflow for coordinators, billers and physicians.
Patient Identification & Stratification
- Automated risk stratification assigns patients to G0556, G0557 or G0558 from diagnosis codes, eligibility data and visit history
- Bulk patient list import with automatic CMS eligibility verification
- Population dashboards to surface care gaps and stratify at-risk patients before billing cycles
- Re-stratification as diagnoses and QMB status change
Care Plan Management
- Condition-specific, customisable templates aligned to CMS documentation requirements
- Structured creation workflows with required fields for goals, medications, providers and barriers
- Version-controlled updates with an audit trail built for CMS review
- Care plan sharing across the care team and back to the chart
Consent & Enrolment
- Digital consent capture via patient portal, SMS or staff-assisted enrolment
- Consent tracking dashboard with expiration alerts and re-consent workflows
- Initial visit verification with automated flags for patients outside the required window
- Enrolment status visible per patient, per tier
Billing & Compliance Automation
- One-click HCPCS generation (G0556 / G0557 / G0558) from confirmed eligibility and care activity
- Automated monthly billing cycle with claim status tracking
- Real-time alerts when documentation is incomplete before claims are generated
- Duplicate-billing guards where a patient is attributed to more than one provider
Care Coordination Tools
- Secure messaging, task assignment and care team communication in-platform
- Transition care workflows for patients discharging from hospital or SNF
- Referral management and specialist coordination with documentation linkage
- Role-based work queues so nothing sits unowned
Patient Communication & Engagement
- Multi-channel outreach: SMS, email, phone and video visit scheduling
- Automated check-in surveys and symptom tracking between visits
- Patient portal access for care plan review, messaging and health data sharing
- Non-responder escalation paths
Care Team Model
HealthArc’s APCM Care Management Services
HealthArc is a software platform, and it’s also a care team. Practices that want to outsource or augment the care coordination function can run APCM on a managed services model instead. That matters most for smaller primary care practices that don’t have the internal staff to operate APCM at scale.
Outreach & Enrolment
HealthArc coordinators contact eligible Medicare beneficiaries, explain the APCM program and obtain documented consent on your practice’s behalf.
Care Plan Development & Maintenance
Coordinators build and update individualised care plans from provider input, patient goals and clinical data. Documentation stays current and audit-ready.
Chronic Disease Monitoring
Structured check-ins by phone, SMS or video to monitor symptoms, medication adherence and care plan compliance between visits.
Transition Care Coordination
When a patient is discharged from a hospital or post-acute facility, the team initiates the transition workflow, schedules follow-up and reconciles medications.
Billing Documentation Support
At the close of each billing period the care team confirms that documentation is complete and that each patient meets tier criteria before claims are submitted.
Supervised, Scoped, Documented
Coordinators are supervised by licensed clinical staff. Every interaction is documented in-platform and visible to the billing physician at any time.
Option 1
Software only
Your clinical staff run APCM in HealthArc. The platform handles stratification, consent, care plans and the monthly billing cycle; your team owns every patient interaction.
Best for: practices with 3+ care management staff
Option 2
Managed care coordination
HealthArc’s coordinators run outreach, enrolment, monitoring and documentation as an extension of your practice, under your providers’ oversight.
Best for: practices new to APCM billing
Option 3
Hybrid
Split the panel: your staff keep the patients they know, HealthArc absorbs the volume beyond capacity, commonly the G0556 tier where per-patient economics are thinnest.
Best for: large Medicare panels beyond staff capacity
The care team operates within a defined scope that supports (and never replaces) the physician-patient relationship. Physicians remain the billing provider and retain clinical decision-making.
Billing & Reimbursement
APCM Billing Codes, Requirements and Reimbursement
APCM uses three HCPCS Level II codes. Each corresponds to a patient risk tier with specific eligibility requirements. Unlike CCM, APCM requires no time documentation. Reimbursement is monthly, per patient, and based on fulfilling defined service requirements.
~$10 / mo
G0556
Level 1: Low Complexity
- One chronic condition
- Seen by billing provider within past 36 months
- Consent and comprehensive care plan on file
~$50 / mo
G0557
Level 2: Moderate Complexity
- Two or more chronic conditions of 12+ months’ duration
- Seen by billing provider within past 12 months
- Consent and comprehensive care plan on file
~$110 / mo
G0558
Level 3: High Complexity / QMB
- QMB status plus two or more conditions of 12+ months
- Seen by billing provider within past 12 months
- Highest APCM reimbursement tier
| Code | Level | Patient criteria | Visit requirement | Monthly rate |
|---|---|---|---|---|
| G0556 | Level 1: low complexity | One chronic condition | Seen by billing provider within past 36 months | ~$10 |
| G0557 | Level 2: moderate complexity | Two or more chronic conditions of at least 12 months’ duration | Seen by billing provider within past 12 months | ~$50 |
| G0558 | Level 3: high complexity / QMB | QMB status with two or more chronic conditions of at least 12 months’ duration | Seen by billing provider within past 12 months | ~$110 |
The Monthly Billing Workflow in HealthArc
1
HealthArc flags eligible patients by code level at the start of each month
2
Automated checks verify CMS eligibility, last visit date and consent status
3
Coordinators document monthly care touchpoints in the platform
4
System alerts flag incomplete required fields before the claim is generated
5
HCPCS codes are generated with supporting documentation attached
6
Monthly reimbursement is tracked per patient and per code in the reporting dashboard
| Patient tier | Patients × rate | Monthly revenue |
|---|---|---|
| G0556 (~$10 / patient) | 200 × $10 | $2,000 |
| G0557 (~$50 / patient) | 300 × $50 | $15,000 |
| G0558 (~$110 / patient) | 100 × $110 | $11,000 |
| Estimated total | 600 patients | $28,000 / mo $336,000 / year |
A 600-patient APCM panel split 200 / 300 / 100 across G0556 / G0557 / G0558 is an estimated $28,000 per month, about $336,000 a year.
Calculate Your RevenueKeeping Pace with CMS Rulemaking
CMS has signalled continued development of the APCM framework beyond 2025. Practices operating under APCM should watch each annual Physician Fee Schedule cycle for updates to code definitions, reimbursement rates and qualifying criteria, including QMB criteria and chronic condition definitions. HealthArc’s compliance team monitors CMS rulemaking and updates the platform when changes are finalised, then notifies affected practices.
Reimbursement figures are approximate national non-facility Medicare averages and vary by geographic locality, facility status, payer and calendar year. CMS updates them annually in the Physician Fee Schedule, so don’t treat the numbers here as a quote. Verify current rates at cms.gov or with your MAC before you bill.
Implementation
How HealthArc APCM Implementation Works
Most practices are live within 2 to 4 weeks of contract execution. Implementation is managed by a dedicated onboarding specialist and follows a defined four-phase approach.
1
Week 1
Discovery & Configuration
Kickoff with your onboarding specialist, then practice profile setup.
- Provider roster, billing NPI configuration and payer enrolment verification
- EHR integration initiated: HL7 / FHIR connection or file import
- Patient eligibility file processed with an initial stratification run
2
Weeks 1–2
Staff Training
Role-specific training for care coordinators, billing staff and physicians.
- Live sessions of 60–90 minutes per role, plus an on-demand video library
- Workflow walkthroughs: consent capture, care plan creation, monthly billing cycle
- A designated HealthArc support contact assigned to your practice
3
Weeks 2–3
Pilot Launch
A soft launch on a defined cohort, typically 50–100 patients.
- First consent campaigns and care plan creation under coordinator oversight
- Billing dry run to verify claim generation before live submission
- Issues identified and resolved before full rollout
4
Weeks 3–4
Full Program Go-Live
The full panel is activated across all three APCM tiers.
- First billing cycle completed and claims submitted
- Reporting dashboard activated with baseline metrics
- Monthly check-ins with your account team; quarterly program reviews available
After go-live. Compliance updates, CMS policy monitoring and platform updates are included at no additional configuration cost. Support is available by phone, email and in-platform messaging.
Interoperability
EHR and Health System Integrations
HealthArc connects to your existing EHR through HL7 v2.x interfaces, FHIR R4 APIs or direct file-based exchange, depending on what your system supports. Integration is configured during onboarding. Your team doesn’t re-enter patient data.
- FHIR R4 API: bidirectional real-time exchange of demographics, problem lists, medications and encounter data
- HL7 v2.x (ADT, CCD, ORU): inbound ADT feeds for transition triggers, CCD imports for care plan pre-population
- Direct file import (CSV / XLSX): for practices on systems without API access; lists upload and auto-stratify
- Encounter history is used to verify the “last seen by billing provider” criterion automatically
What Syncs In
Demographics, insurance and eligibility, active problem list, medication list, encounter history, labs and vitals where available.
Drives Stratification
The active problem list and encounter history are what assign a patient to G0556, G0557 or G0558.
Pre-Populates Care Plans
Medication and diagnosis data land in the care plan template instead of being typed twice.
No IT Build
HealthArc manages the technical connection during onboarding.
Commonly Integrated Systems
Epic
athenahealth (athenaOne)
eClinicalWorks
Greenway Health
NextGen Healthcare
Kareo / Tebra
DrChrono
Allscripts / Veradigm
AdvancedMD
Practice Fusion
For systems not listed, HealthArc’s integration team assesses connectivity during discovery. Most systems with CCD export or a supported API can be connected.
Reporting & Analytics
APCM Reporting, Analytics and Program Performance
Real-time visibility into program performance, billing activity and patient outcomes for administrators, care managers and physicians, without manual spreadsheet work.
Program Performance
- Enrolled patients by HCPCS tier with month-over-month trend
- Care gaps: care plan updates due, overdue touchpoints, consent nearing expiry
- Coordinator workload and task completion rates
- Monthly billing cycle status from documentation through reimbursement
Revenue & Billing
- Monthly reimbursement projections from enrolled count and code distribution
- Actual versus projected revenue by provider and location
- Claim status tracking: submitted, adjudicated, denied, resubmitted
- Revenue per patient per month over the program lifetime
Clinical Outcomes
- Chronic condition metrics: HbA1c control, blood pressure, medication adherence
- Admission and ED visit rates, enrolled versus unenrolled Medicare patients
- Care plan goal completion by condition and cohort
- Patient engagement: touchpoint completion, portal logins, survey responses
Export & Audit
- CMS audit-ready exports: care activity logs, timestamps, staff identifiers, consent records
- Custom report builder for payer reporting and ACO quality submissions
- Scheduled report delivery to practice leadership
- Structured formats for population health and data warehouse systems
Compliance & Security
APCM Compliance, Security and HIPAA Readiness
Every feature (from consent capture to billing documentation) is designed to meet CMS APCM guidelines and survive a payer audit.
CMS Compliance Features
- Automated documentation of required APCM service elements for G0556, G0557 and G0558
- Digital consent with date-stamped records, version history and re-consent workflows
- “Last seen by billing provider” verification with automated out-of-window alerts
- Required care plan fields enforced at data entry, not discovered at billing time
HIPAA & Data Security
- Signed BAA with every client practice
- Encrypted at rest (AES-256) and in transit (TLS 1.2+)
- Role-based access by function and location; MFA required for all users
- SOC 2 Type II audited infrastructure with annual third-party penetration testing
- U.S.-based, HIPAA-compliant cloud infrastructure
Audit Readiness
- One-click documentation package per billed patient
- Consent records, care plan versions, activity logs and billing justification in a single export
- No reconstructing records from multiple systems under audit deadline
- Monthly pre-billing compliance review before claims are generated
The audit you should plan for is the one you never get told about in advance. HealthArc flags incomplete documentation before a claim is generated rather than after it’s denied, which is the difference between a compliance workflow and a compliance post-mortem.
Results
What Practices Achieve with an APCM Program
APCM economics are unusually easy to model, because the codes are non-time-based and paid per patient per month. The figures below are arithmetic at approximate national rates, not projections.
$25–55KEst. monthly APCM revenue, 500 qualifying patients at G0557/G0558
2–4 wksTypical time from contract to full program go-live
~$110Monthly rate per QMB patient at the G0558 tier
0Minutes of time tracking required to bill APCM
Identify your QMB population first. The gap between G0557 (~$50) and G0558 (~$110) is the single largest revenue variable in an APCM program, and dual-eligible patients are routinely mis-tiered. HealthArc verifies QMB status against eligibility data during stratification. Model your panel.
Practices migrating from time-tracked CCM commonly cite reduced documentation burden as the operational reason for the switch. Practice-specific outcome data is shared under NDA during evaluation rather than published here.
FAQ
Frequently Asked Questions About Advanced Primary Care Management
The questions practices ask most when evaluating APCM programs and software vendors.
What is Advanced Primary Care Management (APCM)?
Advanced Primary Care Management (APCM) is a CMS Medicare care management program that took effect on January 1, 2025. It consolidates CCM, PCM, TCM and communication technology-based services into a single, non-time-based billing model.
APCM is billed using HCPCS codes G0556, G0557 and G0558, corresponding to patient risk levels based on the number of chronic conditions and QMB status. Unlike CCM, APCM doesn’t require staff to track or document time spent on care activities.
What is the difference between APCM and CCM?
The key differences are billing method, code structure and administrative burden. CCM (CPT 99490, 99439 and related codes) requires practices to document and bill based on time, typically a 20-minute monthly minimum.
APCM uses non-time-based billing: practices bill a single monthly code (G0556, G0557 or G0558) based on patient risk tier, with no time-tracking requirement. APCM also folds multiple legacy service codes into three three G-codes, which cuts a good deal of billing work out of primary care.
What is APCM full form?
APCM stands for Advanced Primary Care Management. It is a CMS initiative under Medicare Part B, introduced in the CY 2025 Physician Fee Schedule, designed to support comprehensive care management for Medicare beneficiaries with chronic conditions in primary care settings.
Who can bill APCM codes?
APCM codes G0556, G0557 and G0558 can be billed by physicians, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives who serve as the billing provider for a Medicare beneficiary.
The patient must have been seen by the billing provider within the required timeframe: 36 months for G0556, 12 months for G0557 and G0558. Only one provider per patient can bill APCM in a given month.
What is a Qualified Medicare Beneficiary (QMB) and why does it matter for APCM?
A Qualified Medicare Beneficiary is a low-income Medicare enrollee who also qualifies for Medicaid assistance with Medicare cost-sharing, a dual-eligible patient.
For APCM, QMB patients with two or more chronic conditions of at least 12 months’ duration qualify for the highest reimbursement tier, G0558, at approximately $110 per patient per month. Practices with a high share of dual-eligible patients benefit substantially from identifying and billing G0558 correctly.
How does HealthArc’s APCM software differ from other care management platforms?
HealthArc’s APCM platform is purpose-built for CMS APCM requirements rather than adapted from a generic chronic care management tool. The differentiators are automated three-tier stratification (G0556/G0557/G0558), EHR integration with named systems including Epic, athenahealth, eClinicalWorks and NextGen, a managed care coordination option for practices without dedicated staff, and pre-billing compliance checks that catch documentation gaps before claims are submitted.
HealthArc also monitors CMS rulemaking and updates the platform as APCM evolves.
How long does it take to implement APCM with HealthArc?
Most practices complete implementation in 2 to 4 weeks: EHR integration setup, patient eligibility stratification, staff training, then a pilot launch before full go-live. A dedicated onboarding specialist is assigned to each practice.
Practices that have previously run CCM or PCM programs usually onboard faster, because the patient data and staff familiarity are already in place.
What is changing with APCM going forward?
CMS releases updates to the APCM framework through the annual Physician Fee Schedule rulemaking cycle. Areas of likely change include reimbursement rate adjustments, updates to QMB criteria, changes to qualifying chronic condition definitions and possible expansion of covered services within each billing tier.
HealthArc monitors CMS rulemaking and updates the platform and notifies practice clients of changes affecting billing eligibility or documentation requirements.
Get Started
Ready to Launch Your APCM Program?
If your practice has a Medicare patient panel with chronic conditions, you are most likely leaving APCM reimbursement on the table. HealthArc can help you identify your eligible population, configure your program and submit your first billing cycle, in as little as four weeks.
- An APCM specialist reviews your Medicare panel and estimates your G0556/G0557/G0558 opportunity
- A live walkthrough of consent capture, care plan management, billing cycle and reporting
- A written implementation proposal with timeline, integration requirements and pricing
- No long-term contracts required for initial engagement
- EHR integration support included
Schedule Your APCM Demo
Estimate APCM Revenue
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Resources
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Guidance on APCM eligibility, G0556–G0558 billing and migrating a CCM program to APCM.
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