The recently finalized Advanced Primary Care Management (APCM) codes in CMS’s 2025 Physician Fee Schedule mark a pivotal shift in supporting value-based care for primary and chronic care patients. This move by CMS strengthens primary care through bundled services that streamline the administrative processes associated with managing chronic conditions, improve patient care continuity, and provide an opportunity to expand Remote Patient Monitoring (RPM) services.
As RPM and Chronic Care Management (CCM) have shown, providing ongoing support for patients with chronic conditions can enhance outcomes and reduce healthcare costs. Now, with the introduction of APCM codes, providers can leverage a simplified, patient-centered approach while supporting advanced primary care models.
Understanding the New APCM Codes
CMS’s finalized APCM services introduce three new HCPCS G-codes to cover varying levels of patient complexity without the constraints of time-based billing. Here’s a breakdown of these new codes and what they mean for providers:
- G0556 (Level 1): For patients with one chronic condition, offering a baseline reimbursement rate that has been recently increased in response to stakeholder feedback.
- G0557 (Level 2): For patients with two or more chronic conditions, providing a higher reimbursement.
- G0558 (Level 3): For patients with two or more chronic conditions and designation as a Qualified Medicare Beneficiary (QMB), reflecting higher complexity due to social determinants of health and access challenges.
Unlike traditional CCM and other care management codes, these APCM codes eliminate time-based thresholds, making them more accessible for practices while reducing administrative burdens.
How APCM Codes Transform Care Delivery
The APCM codes represent more than just new billing opportunities—they support a fundamental transformation in how primary care is delivered. Practices using APCM codes can provide comprehensive, continuous care through essential service elements, including:
- 24/7 Access to Care: Ensuring patients have continuous access to urgent care services.
- Continuity of Care: Offering a designated team member for routine appointments, fostering stronger patient relationships.
- Enhanced Care Transitions and Coordination: Helping patients navigate care transitions smoothly, improving outcomes and reducing readmissions.
- Patient-Centered Comprehensive Care Plans: Managing care through individualized plans available to both patients and providers.
Incorporating these elements within APCM provides a framework that supports high-quality, accessible, and proactive primary care. The codes align with CMS’s commitment to improving health outcomes and health equity by simplifying billing requirements, reducing documentation demands, and expanding primary care access for complex patients.
Synergy Between APCM and Remote Patient Monitoring (RPM)
One of the most exciting aspects of APCM is its compatibility with RPM and Remote Therapeutic Monitoring (RTM). By using APCM to manage primary care services, practices can apply all time-based activities previously attributed to CCM directly to RPM codes. This means:
- Maximized RPM Reimbursement: Since RPM activities are not part of APCM billing, practices can focus RPM time on activities like monitoring vital signs and patient reminders, optimizing RPM billing opportunities.
- Streamlined Workflows: With APCM managing chronic care activities without time tracking, RPM can function without overlaps or time splits, simplifying workflows.
- Improved Patient Engagement: Patients benefit from consistent engagement through RPM, with clinicians using APCM to provide integrated support for a wide range of care needs.
Why Now is the Time for Practices to Adopt APCM and RPM
With finalized APCM codes, practices can now benefit from a hybrid payment model that reduces the burden of tracking every minute while still delivering quality, comprehensive care. Here’s why providers should consider adopting APCM codes alongside RPM:
- Reduced Administrative Burden: By replacing time-based requirements, APCM offers a more flexible, streamlined billing process.
- Improved Profitability and Patient Reach: APCM opens opportunities to include more patients in care management programs, especially those who may not have qualified under time-based CCM or PCM codes.
- Support for Socially Complex Patients: The Level 3 code provides additional reimbursement for patients facing social and economic barriers, aligning with CMS’s goals to improve health equity.
- Integrated Value-Based Care Model: The combination of APCM and RPM supports CMS’s vision of a value-based healthcare system, where patient outcomes are prioritized and healthcare costs are reduced.
Realizing APCM’s Full Potential with Optimize Health
As a leader in remote care, Optimize Health understands the challenges and opportunities of delivering advanced care management. By partnering with Optimize Health, practices can maximize the benefits of APCM codes and RPM:
- Enhanced Patient Outcomes: By leveraging RPM, practices can maintain real-time monitoring for chronic conditions, enhancing patient outcomes and satisfaction.
- Data-Driven Insights and Compliance: With support in data analytics and Medicare compliance, practices can ensure their programs align with CMS guidelines while optimizing performance and profitability.
- Seamless Integration and Support: Optimize Health provides managed RPM solutions, allowing your team to focus on patient care while we handle RPM logistics and compliance.
Conclusion
The finalized APCM codes represent a significant step forward in supporting value-based primary care. By adopting APCM alongside RPM, practices can deliver higher-quality, more accessible, and equitable care to patients with chronic conditions. Now is the time to integrate these transformative codes into your practice, simplify billing processes, and focus on what matters most: providing exceptional patient care.
To learn more about how Optimize Health can support your adoption of APCM and RPM, contact us today for a consultation.