HealthArc’s APCM model focuses on the intensity of care, continuous access to care, coordination of care and care transitions, including support for patients transitioning from hospital stays back to home care by adopting value-based care models.

Brief Overview of the Latest Advanced Primary Care Management (APCM) CPT Codes for 2026

There are three major APCM CPT Codes, based on the level of medical complexity and multidisciplinary involvement, coordination, and continuous monitoring of patients.

G0556: Level 1 APCM (Low Complexity)

For a patient with one or more chronic conditions under the ongoing care of the Primary Care Physician (PCP).
No minimum amount of time is required.
Includes care coordination, patient collaboration through communication with the PCP, medication monitoring, and immediate access to care.
Can be billed monthly.

G0557: Level 2 APCM (Moderate Complexity)

For patients who have multiple chronic conditions or care needs that exceed the level of care provided under Level 1. This includes support for the development of multidisciplinary enhanced care through additional planning and monitoring.
No defined minimum amount of time is required.
Can be billed on a monthly basis.

G0558: Level 3 APCM (High Complexity)

For patients who have significant medical complexity or require multiple adjustments to care.
Includes significant levels of multidisciplinary involvement, coordination, and continuous monitoring of the patient.
Can be billed on a monthly basis.

Who Can Bill for APCM?

All the APCM CPT codes can be reported and billed by:

Primary Care Physicians (PCPs, MDs, DOs)
Nurse Practitioners (NPs)
Physician Assistants (PAs)
Non-Physician Practitioners (NPPs)
Clinical Nurse Specialists (CNSs)

Clinical staff can assist with coordination, but the billing provider must document and supervise care and maintain compliance, acting as the patient’s primary care provider.

Latest Medicare Reimbursement for APCM Services in 2026

Medicare reimbursement for the commonly billed APCM codes:

G0556: approximately $15–$25 per month
G0557: approximately $50–$60 per month
G0558: approximately $90–$110 per month

Note: Rates vary by region and billing practitioner. Commercial payers may reimburse at higher rates. All reimbursements must adhere to CMS guidelines.