If you’re a primary care provider or part of a billing team, you’ve likely heard about the new 2025 codes—G0556, G0557, and G0558—for Advanced Primary Care Management (APCM). You might be wondering, "How can we efficiently implement and bill for these services?" With so many care management codes available, it’s easy to feel overwhelmed. However, one thing is certain: care management services are here to stay!

A well-structured care management program enhances patient outcomes, reduces healthcare costs, and ensures timely, continuous support through improved care coordination and patient engagement. 

Why Bill for These Codes?

Primary care providers manage their patients’ overall health and coordinate essential services. Medicare acknowledges this effort by offering reimbursement for the care management work you’re likely already providing. Billing for APCM services allows you to receive compensation for managing chronic conditions with simplified documentation and billing requirements. These codes do not require time tracking but are based on patient qualifiers, simplifying billing, and expanding eligibility. All of this supports long-term sustainability, enhances patient care, and aligns with value-based care models.

Breakdown of the New APCM Codes:

• G0556 – APCM for a patient with one chronic condition* or fewer, managed by clinical staff under physician supervision, per month.
• G0557 – APCM for a patient with multiple (two or more) chronic conditions*.
• G0558 – APCM for a qualified Medicare beneficiary with multiple (two or more) chronic conditions^*.

*Chronic conditions are those expected to last at least 12 months or until the patient’s death, posing significant risks such as acute exacerbation or functional decline.

Historically, care management services have added administrative burdens for practices. The time-based nature of these services requires accurate documentation of care management activities. Workflows—both clinical and technological—must ensure that time thresholds are met before claims can be submitted.

Tips for Implementing APCM Services

Step 1: Understand the New Codes

• Review CMS billing requirements, from patient consent to billing guidelines.
• Ensure staff are well-informed and engaged in the process.

Step 2: Identify the Target Population

• Use data analytics to identify patients with chronic conditions.
• Consider social determinants of health (SDOH) to include at-risk patients.

Step 3: Establish an Optimal Workflow

• Define roles for key team members, such as referral specialists and care coordinators.
• Conduct a gap analysis of your electronic health record (EHR) and billing systems.
• Enhance communication with secure messaging and patient portals.

Step 4: Start Small, Then Scale

• Begin with a small pilot program and track processes from start to finish.
• Document policies, refine workflows, and provide ongoing staff training based on CMS guidelines.
• Expand gradually to ensure smooth implementation and maximize reimbursement.

Final Thoughts: Don’t Let Complex Billing Processes Associated with Other Care Management Services Hold You Back

Many practices already provide these valuable services but miss out on reimbursement. CMS offers a wealth of information, and with a clear plan and streamlined process, you can unlock new revenue opportunities while improving patient care and outcomes.

Need more guidance? Visit CMS - Advanced Primary Care Management Services to learn more.

Take the next step—implement these strategies today for a win-win outcome for both your practice and your patients!

Published: 04/08/2025

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