New HCPCS codes for advanced primary care management can boost revenue
Learn how CMS’s new advanced primary care management codes for 2025 can boost revenue — and get implementation steps for APCM services.

At a Glance
- CMS has introduced new advanced primary care management (APCM) codes for 2025 that offer medical practices payment rates ranging from $15 to $110 for managing patients with chronic conditions.
- Unlike existing care management services, APCM codes eliminate time-based thresholds while focusing on essential care elements like 24/7 access, care transitions, and comprehensive care plans.
- Medical practices can prepare for APCM implementation by evaluating their technology infrastructure, developing patient consent workflows, and identifying eligible patients with chronic conditions and QMB status.
Buried deeply within the 3,000+ page calendar year 2025 physician fee schedule (PFS) final rule are 3 new healthcare common procedure coding system (HCPCS) codes that may help medical practices increase patient access to high quality primary care services and generate more revenue. We’re talking about these new codes for advanced primary care management (APCM) services:
- G0556: APCM for patients with one chronic condition (work relative value unit [RVU] of 0.25 and average national non-facility payment rate of $15 in 2025)
- G0557: APCM for patients with 2 or more chronic conditions (work RVU of 0.77 and average national non-facility payment rate of $50 in 2025)
- G0558: APCM for patients with 2 or more chronic conditions and status as a qualified Medicare beneficiary (QMB) (work RVU of 1.67 and average national non-facility payment rate of $110 in 2025)
Here's what medical practices need to know about these new codes and how to prepare for implementing them in 2025.
What is advanced primary care management?
Per the Centers for Medicare & Medicaid Services (CMS), APCM is a comprehensive approach to coordinating patient care. It incorporates elements of principal care management, transitional care management, and chronic care management. APCM enables healthcare providers to deliver holistic care coordination and management services for patients with chronic conditions, focusing on preventive care, care transitions, and ongoing condition management. However, unlike these existing care management services, there are no time-based thresholds with APCM — a deliberate step designed to reduce administrative burden. This means providers can focus on delivering necessary care elements based on each patient's needs rather than tracking specific time requirements.
Benefits of advanced primary care management
In the CMS 2025 PFS final rule, the agency says new advanced primary care management codes will:
- Better recognize and describe advanced primary care services
- Encourage primary care practice transformation
- Help ensure that patients have access to high quality primary care services
- Simplify billing and documentation requirements
While there are no time-based thresholds, advanced primary care management codes do require physicians to perform and document specific elements when medically necessary. These include patient consent, initiating visit for a new patient, 24/7 access and continuity of care, comprehensive care management, patient-centered comprehensive care plan, management of care transitions, care coordination, enhanced communication, population-level management, and performance measurement.
While the scope of service elements for advanced primary care management services is quite extensive, CMS says all these elements may not be medically necessary for every patient during each month. For example, a patient may have no hospital admissions that month, so there is no management of a care transition after hospital discharge. However, what’s critical is that billing practitioners and auxiliary personnel have the ability to furnish every service element, as appropriate, for any individual patient during any calendar month.
“What’s critical is that billing practitioners and auxiliary personnel have the ability to furnish every service element, as appropriate, for any individual patient during any calendar month.”
For example, a patient with heart failure and chronic kidney disease begins to experience swollen legs. The patient should be able to submit a photo or video to the practitioner via a secure communications system, and the practitioner must be able to interpret and communicate remotely with the patient about those images.
Note that there’s good news for Merit-based Incentive Payment System-eligible clinicians: these clinicians can satisfy the performance management service element of advanced primary care management by participating in the Value in Primary Care MIPS Value Pathway (MVP).
6 steps to prepare for APCM implementation
The CMS 2025 PFS final rule devotes more than 100 pages to APCM services (see pages 395–526 of the final rule), which means there’s certainly a lot of information to digest. We combed through the information and developed several steps medical practices can take now to prepare. However, medical practices should read the APCM section of final rule in its entirety if they intend to provide these services.
1. Determine whether APCM may be appropriate for your medical practice
Advanced primary care management services are not limited to practitioners in specific specialties. CMS anticipates clinicians working in general medicine, geriatric medicine, family medicine, internal medicine, and pediatrics will report advanced primary care management services codes most frequently. However, the agency acknowledges that other specialists (e.g., OB/GYN) may also function as primary care practitioners who serve as the focal point for all needed healthcare services.
Note that if your medical practice already participates in a shared savings program accountable care organization; a realizing equity, access, and community health ACO (REACH ACO); a primary care first practice; or a making care primary practice, it may even already satisfy the requirements to bill APCM.
2. Decide who will provide the APCM service
Physicians or practitioners (i.e., nurse practitioners, physician assistants, certified nurse midwives, or clinical nurse specialists) can bill APCM monthly following the initial qualifying visit (for new patients) when those providers intend to serve as the focal point for all the patient’s necessary healthcare services. Auxiliary personnel may provide advanced primary care management services under the general supervision of the billing practitioner.
However, note that there are concurrent billing restrictions. This means that the practitioner providing the advanced primary care management services may not be able to bill for certain other services (see table 26 in the CMS 2025 PFS final rule for a complete list) when they perform both services for the same patient during the same month.
3. Evaluate your health information technology
In the CMS 2025 PFS final rule, the agency requires the use of certified electronic health records (EHR) technology to bill for APCM services. That’s because CEHRT ensures that practitioners can provide the full scope of APCM services, including the requisite 24/7 access to care, continuity of care, management of care transitions, and more.

4. Look for efficient ways to provide the APCM “initiating visit” for new patients
The initiating visit, furnished in person or via telehealth in advance of advanced primary care management services, establishes a relationship between the patient and billing provider, and it allows the billing provider to gather comprehensive health information to inform the care plan. This doesn’t necessarily need to be a standalone visit specifically for APCM. Providers may be able to use any of the following as the initiating visit for APCM:
- Level 2 through 5 evaluation and management visit
- Medicare annual well-being visit
- Initial preventive physician exam
- Transitional care management service
Think about ways to leverage these visits to initiate APCM for new patients, when appropriate.
5. Develop a strategy for patient consent
CMS says medical practices can leverage the consent process as an opportunity to educate patients about APCM services and discuss the service elements and capabilities that make the medical practice qualified to perform these services. This is also an opportunity to ensure patients are not receiving APCM services elsewhere.
6. Establish internal workflows to ensure proper identification of patients with QMB status
CMS says practitioners have access to this information when verifying a patient’s Medicare eligibility, and QMB information is also available in the Medicare Remittance Advice for fee-for-service claims after claims processing. The agency advises medical practices to ask their third-party eligibility verification vendors how their products reflect QMB information.
Looking ahead with advanced primary care management codes
New advanced primary care management codes may provide medical practices with an avenue to help patients in need while also generating additional revenue. Taking a proactive approach to implementing these 2025 CPT updates, along with ensuring the right technology is in place, will help medical practices be successful.
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