APCM codes 2026 support a monthly, whole-person approach to advanced primary care management (APCM) for Medicare patients. The Centers for Medicare & Medicaid Services (CMS) created them in the CY 2025 Physician Fee Schedule (PFS) final rule. For 2026, the CY 2026 PFS final rule kept the three base codes and added optional behavioral health add-ons.
Advanced primary care management brings elements of chronic care, principal care, and transitional care management into one monthly service. The model centers on the patient rather than on minutes logged. Care teams focus on access, coordination, and prevention for the whole person.
Chronic disease is a major reason this model matters. A CDC study found that 51.8% of U.S. adults had at least one chronic condition in 2018. More than one in four (27.2%) had two or more. Prevalence was highest among Americans 65 and up. Adults with multiple chronic conditions tend to have lower quality of life and higher health care costs. They also face a higher risk of death.
This guide covers:
- What APCM is and who can bill it
- The three APCM codes and their 2026 payment rates
- The new 2026 behavioral health add-on codes
- APCM service elements and billing requirements
- How APCM differs from chronic care management (CCM)
- How remote patient monitoring (RPM) supports APCM care plans
- What to watch for in 2027
What Is Advanced Primary Care Management?
Advanced primary care management is a monthly bundle of care management and communication services for Medicare patients. According to CMS, APCM combines elements of principal care management (PCM), transitional care management (TCM), and CCM. It also includes communication technology-based services such as virtual check-ins, remote evaluations of patient-recorded information, and interprofessional consultations.
The practitioner who bills APCM agrees to be responsible for the patient’s primary care. That practitioner also serves as the continuing focal point for all needed health care services. CMS designed the codes mainly for primary care specialties such as family medicine, internal medicine, geriatric medicine, and pediatrics.
APCM is not time-based. A practice bills one APCM code per patient per calendar month when it meets the billing requirements. This removes minute-by-minute tracking and lets care teams direct more of their effort toward the patient.
Who Can Bill APCM Services?
Physicians and non-physician practitioners can bill APCM. This includes nurse practitioners, physician assistants, and clinical nurse specialists. The billing practitioner must be responsible for the patient’s primary care and must have the patient’s consent.
Auxiliary personnel, such as nurses and care coordinators, can furnish APCM services under general supervision. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can also bill APCM. The CMS APCM FAQ states that these services are paid at the PFS non-facility rate for FQHCs and RHCs.
What Are the APCM Codes for 2026?
APCM codes 2026 use three HCPCS G-codes. Each tier reflects the patient’s medical and social complexity. CMS asks practices to choose the code that best matches each patient.
- G0556 (Level 1): Patients with one or fewer chronic conditions.
- G0557 (Level 2): Patients with two or more chronic conditions. These conditions must be expected to last at least 12 months, or until death. They must also place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
- G0558 (Level 3): Patients who are Qualified Medicare Beneficiaries (QMBs) with two or more qualifying chronic conditions.
The QMB program helps people with limited income and resources pay Medicare premiums and cost sharing. Providers may not bill QMB individuals for Medicare cost sharing. The higher Level 3 valuation reflects the added social complexity many of these patients face.
2026 Payment Rates for APCM Codes
Medicare prices APCM in both facility and non-facility settings. The table below shows approximate CY 2026 national non-facility averages.
| Code | Level | Patient Profile | Approximate 2026 National Non-Facility Average |
|---|---|---|---|
| G0556 | Level 1 | One or fewer chronic conditions | About $16 per month |
| G0557 | Level 2 | Two or more chronic conditions | About $54 per month |
| G0558 | Level 3 | QMB with two or more chronic conditions | About $117 per month |
Facility rates are lower. Actual payment varies by locality, setting, and payer, and patient cost sharing may apply. Practices can confirm local amounts with the CMS Physician Fee Schedule Look-Up Tool.
This material is provided for general informational and educational purposes only and does not constitute legal, compliance, billing, coding, or reimbursement advice. CPT® codes, descriptions, and Medicare payment rates referenced here are drawn from publicly available sources, are subject to change, and may vary by payer, locality, and patient circumstances. Tenovi makes no representation or guarantee regarding coverage, payment, or the appropriateness of any code for a particular patient or service, and any presented are illustrative only. Providers are solely responsible for independently determining medical necessity and applicable coding, coverage, documentation, and billing requirements and for submitting accurate claims. Consult applicable payer guidance and qualified billing, coding, compliance, or legal professionals before making billing decisions. CPT® is a registered trademark of the American Medical Association.
What’s New for APCM in 2026: Behavioral Health Add-On Codes
Behavioral health and physical health are closely connected. In its CY 2026 PFS final rule fact sheet, CMS noted that integrated behavioral health can reduce depression severity. It can also improve the patient’s overall experience of care.
For 2026, CMS finalized three optional add-on codes for APCM. Each add-on is billed only when the same practitioner reports an APCM base code in the same month. The services are designed to be directly comparable to existing Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes.
- G0568: Based on CPT® code 99492. Covers the initial month of psychiatric CoCM services for patients receiving APCM.
- G0569: Based on CPT® code 99493. Covers subsequent months of CoCM services for patients receiving APCM.
- G0570: Based on CPT® code 99484. Covers general BHI services for patients receiving APCM.
According to the CY 2026 final rule in the Federal Register, these add-ons remove the time-based requirements of existing BHI and CoCM codes. CMS expects this to reduce documentation burden. RHCs and FQHCs may also report G0568, G0569, or G0570 when they integrate behavioral health with APCM.
For patients, this means depression, anxiety, and substance use concerns can be addressed within the same primary care relationship. Treating the whole person often supports better management of physical chronic conditions as well.
APCM Service Elements and Billing Requirements
APCM is built around a defined scope of service. The CMS APCM FAQ explains that practices must be able to furnish every element during any month they bill APCM. Not every element must be delivered every month. Services should be delivered as medically reasonable and necessary for each patient.
CMS offers a helpful example. A patient with heart failure and chronic kidney disease might send a photo of swollen legs. The practitioner must be able to interpret that image remotely. By billing APCM, the practitioner attests that the code requirements have been met.
The APCM service elements include:
- Patient Consent: Obtain written or verbal consent and document it in the medical record. Patients must learn that only one practitioner can furnish APCM each month. They must also learn that they can stop at any time and that cost sharing may apply. Consent is needed only once.
- Initiating Visit: New patients need an initiating visit, which is paid separately. It is not required if the practice has seen the patient within three years. It is also not required if the practice provided APCM, CCM, or PCM within the past year. Qualifying visits include E/M levels 2 through 5, the TCM face-to-face visit, the Annual Wellness Visit, and the Initial Preventive Physical Exam. APCM must be discussed during the visit.
- 24/7 Access and Continuity of Care: Patients and caregivers can reach the care team for urgent needs at any hour. Each patient has a designated care team member for routine appointments. Practices also offer alternatives to office visits, such as home visits or expanded hours.
- Comprehensive Care Management: This includes medical and psychosocial needs assessments, preventive care tracking, and medication reconciliation and management.
- Electronic Patient-Centered Care Plan: The care team develops, updates, and shares a comprehensive care plan. The patient or caregiver receives a copy.
- Care Transitions: The team manages referrals and follows up after emergency visits and discharges. Follow-up should occur within seven days of discharge, as clinically indicated.
- Home- and Community-Based Care Coordination: The team shares the patient’s goals and needs with community service providers, hospitals, skilled nursing facilities, and other practitioners.
- Enhanced Communication: Patients can use secure messaging, email, or a patient portal. The practice can also review patient-recorded information and support patient-initiated digital visits.
- Population-Level Management: The practice analyzes population data to find gaps in care. It also risk stratifies patients to target services where they are needed.
- Performance Measurement: MIPS-eligible clinicians report the Value in Primary Care MIPS Value Pathway. Participation in certain accountable care organizations or CMS Innovation Center models can also meet this requirement.
APCM vs. CCM: Key Differences
APCM and CCM share a goal of coordinated, proactive care. They differ in scope, eligibility, and structure. Understanding the differences helps practices choose the best fit for each patient.
- Time requirements: CCM is time-based and requires documented minutes each month. APCM has no minimum time requirement.
- Scope: CCM focuses on chronic care management. APCM adds elements of PCM, TCM, and communication technology-based services.
- Eligibility: CCM requires two or more chronic conditions. APCM is available to any consenting Medicare patient, including patients with one or no chronic conditions.
- Billing practitioner: APCM is billed by the practitioner responsible for the patient’s overall primary care. CCM can be billed by practitioners across specialties.
- Structure: CCM uses base and add-on time codes. APCM uses a tiered monthly code based on patient complexity.
Can APCM Be Billed With Other Care Management Services?
The practitioner billing APCM cannot also bill CCM, PCM, or TCM for the same patient in the same month. The same applies to overlapping communication services such as virtual check-ins and e-visits. In the CY 2025 final rule, CMS limited these restrictions to the practitioner furnishing APCM.
Practices do not have to choose one program for every patient. A practice can use APCM for some patients and CCM for others, based on each patient’s needs.
How Remote Patient Monitoring Supports APCM
Remote patient monitoring and remote therapeutic monitoring (RTM) are separate services with their own billing requirements. A patient enrolled in APCM can also receive RPM or RTM when each service’s requirements are met. Care teams should document each service separately and avoid counting the same effort twice.
RPM gives the APCM care team a clearer view of the patient between visits. Connected devices such as blood pressure monitors, weight scales, glucometers, and pulse oximeters transmit readings to the care team. When readings move outside set thresholds, the team can respond sooner.
This data supports several APCM service elements:
- Comprehensive care management: Trends in blood pressure, weight, or glucose help guide medication adjustments and self-management coaching.
- Care plan updates: Objective readings help the team revise goals based on how the patient is doing at home.
- Care transitions: Daily weights after a heart failure discharge can flag fluid gain early, supporting timely follow-up.
- Population-level management: Aggregated readings help practices risk stratify their panel and identify patients who need more support.
Tenovi’s cellular-connected devices and the Tenovi Gateway send readings automatically, without Wi-Fi or smartphone setup. That simplicity supports consistent use for patients who want a plug-in experience at home. For current RPM billing details, see our guide to 2026 RPM CPT codes.
Benefits of APCM for Patients and Care Teams
APCM supports a proactive, preventive model of primary care. Key benefits include:
- Continuity: Patients have a designated care team member and around-the-clock access for urgent needs.
- Whole-person care: Medical, psychosocial, and, beginning in 2026, behavioral health needs can be addressed together.
- Less administrative burden: Care teams spend less time tracking minutes and more time with patients.
- Stronger transitions: Follow-up after emergency visits and hospital discharges is built into the service.
- Caregiver involvement: Caregivers receive the care plan and can contact the care team when needed.
- Population health insight: Risk stratification helps practices find care gaps before they lead to complications.
Frequently Asked Questions About APCM Codes 2026
CMS released the CY 2027 PFS proposed rule on July 14, 2026. The public comment period closed on September 14, 2026. The proposal includes a request for information on redesigning primary care payment. It also proposes lower conversion factors for 2027.
A final rule is expected in early November 2026, with finalized policies effective January 1, 2027. Until then, the current APCM codes and requirements remain in effect. Tenovi will update this guide once the final rule is published.
1) What are the APCM codes for 2026?
The APCM codes for 2026 are G0556, G0557, and G0558. G0556 covers patients with one or fewer chronic conditions. G0557 covers patients with two or more chronic conditions. G0558 covers Qualified Medicare Beneficiaries with two or more chronic conditions.
2) What changed for APCM in 2026?
CMS added three optional behavioral health add-on codes: G0568, G0569, and G0570. They are billed with an APCM base code by the same practitioner in the same month. They support CoCM and general BHI services without time-based requirements.
3) Can APCM and CCM be billed for the same patient in the same month?
No. The practitioner billing APCM cannot bill CCM, PCM, or TCM for the same patient in the same month. A practice can still use APCM for some patients and CCM for others.
4) Can remote patient monitoring be provided alongside APCM?
Yes. RPM and RTM are separate services with their own requirements. A patient in APCM can also receive RPM or RTM. Each service’s requirements must be met, and effort should be documented separately.
5) Does APCM require a minimum amount of time each month?
No. APCM has no monthly time threshold. Practices must be able to furnish all APCM service elements and deliver them as medically reasonable and necessary.
6) Which practitioners can bill APCM services?
Physicians, nurse practitioners, physician assistants, and clinical nurse specialists can bill APCM. The billing practitioner must be responsible for the patient’s primary care. FQHCs and RHCs can also bill APCM.
Understanding APCM Codes 2026
APCM codes 2026 support a patient-centered, whole-person approach to primary care. The three base codes, G0556, G0557, and G0558, reflect patient complexity without requiring minute tracking. New behavioral health add-on codes allow practices to integrate mental health care within the same primary care relationship. Practices must be able to furnish every APCM service element and deliver each as the patient needs. RPM and RTM can complement APCM by giving care teams timely data between visits. With the CY 2027 final rule expected soon, practices should watch for further updates to advanced primary care management.
Tenovi provides cellular-connected RPM and RTM devices and data infrastructure. We serve RPM software companies, care management organizations, telehealth platforms, and health systems. Our FDA-cleared devices and the Tenovi Gateway help care teams keep patient data flowing between visits. Contact us for a free demo and consultation to learn how Tenovi can support your care programs.
