Home/Services/Advanced Primary Care Management
APCM · Service Detail

Medicare's newest care-management pathway, without the time-tracking burden

APCM pays a flat monthly rate tiered by patient complexity — no minute-by-minute time logs required — for comprehensive care management delivered under a whole-person, team-based model.

HCPCS G0556HCPCS G0557HCPCS G0558
Talk to us about APCM All 11 services
What It Is

Advanced Primary Care Management, introduced by CMS, consolidates much of what CCM, PCM, and general care coordination required into one simplified, tiered monthly payment — removing the strict time-tracking rules that made older programs administratively heavy for smaller practices.

In exchange, APCM requires a real primary-care relationship: 24/7 access to care team and health information, a certified EHR, comprehensive care management, and a commitment to patient-centered, whole-person care. Elixir builds the operating workflow that satisfies those requirements so the billing holds up under review.

What's included

  • Tier classification & eligible-patient identification
  • 24/7 access line & after-hours care coordination workflow
  • Comprehensive care plan development & maintenance
  • Whole-person care coordination across specialists
  • Patient population health tracking
  • Documentation aligned to APCM's non-time-based requirements
  • Monthly reporting by tier & panel
Who Qualifies
  • Patient has an established primary care relationship with your practice
  • Practice uses a certified EHR meeting APCM requirements
  • Practice can provide 24/7 patient access to care team or coverage
  • Comprehensive, whole-person care management is documented
Eligibility is confirmed by your clinical team — Elixir verifies documentation, not medical necessity.
CodeDescription
G0556Tier 1 — patients with 0-1 chronic conditions
G0557Tier 2 — patients with 2+ chronic conditions
G0558Tier 3 — Qualified Medicare Beneficiaries with 2+ conditions
Common Questions

Advanced Primary Care Management, answered plainly

How is this different from CCM?+
APCM removes the minute-by-minute time logging CCM requires and replaces it with a flat monthly rate by complexity tier. It's designed to be simpler to administer, but it requires broader practice-level capabilities like 24/7 access, which Elixir helps build and document.
Can we bill APCM and CCM for the same patient?+
No — CMS structures these as mutually exclusive care-management pathways per patient per month. Part of Elixir's consulting work is helping your practice decide which pathway fits each population best.
Is APCM only for primary care?+
APCM is built around the primary-care relationship, so it's most relevant for practices serving as a patient's principal source of continuous, comprehensive care.
Pairs Well With

Related services

CCM

Chronic Care Management

Monthly care your patients feel — documented so your practice can bill it

CNS

Healthcare Consulting

Opportunity analysis, program design, and financial modeling.

PCM

Principal Care Management

Focused management of the one condition driving a patient's risk

Next Step

See APCM modeled on your own patient panel

Bring your panel size and payer mix to a 60-minute opportunity session and leave with a specific, numbers-based program design.

Book the Session info@elixirhc.com

Session Agenda

  1. Patient population & payer mix
  2. Current APCM activity, if any
  3. EHR & documentation workflow
  4. Staffing & device strategy
  5. Pilot design for this service
  6. Your clinic-specific opportunity model