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Advanced Primary Care Management

Simplify APCM care management.

Manage APCM care plans, coordination, and monthly billing preparation alongside Medicaid RPM in one patient record. The patient's primary care provider bills Medicare for APCM.

Request a demoHow RPM Medicaid works

ALVAREZ, Marisol · 68 yrs

  • #RPM Medicaid
  • #APCM

Authorization

Approved· 8 of 8 steps

Jun 22 – Dec 18, 2026

Consent · Verbal

Reading days · Oct 202624 of 30

24 days →U821–25 reading days

Billed to TMHP by the agency

This month’s code

G0558Level 3

  • I10Hypertension
  • E11.9Type 2 diabetes
  • QMB
  • Consent

Care this month

  • Care plan updated, doneOct 3
  • Follow-up after discharge, doneOct 9
  • Medication review, to doDue Oct 28

CCM held · APCM active

Billed to Medicare by the provider

Oct 2026 billing cycle

  • S9110-U8ReadyRPM MedicaidAgency → TMHP
  • G0558ReadyAPCMProvider → Medicare
  • 99490Held · APCM monthCCMNot billed

One patient · two billers · in one patient record

Illustration with sample data. Confirm coverage for each patient before you bill.

One patient, two programs

Agency and provider billing in one patient record

Texas Medicaid RPM and Medicare APCM have different billing responsibilities. The agency monitors at home and bills Texas Medicaid. The primary care provider manages the patient’s care and bills Medicare.

The flagship

RPM Medicaid

S9110

Billed by
The home health agency
Paid by
Texas Medicaid, through TMHP or a health plan
Paid for
Reading days each month
Care delivered by
The agency’s own nurses
How RPM Medicaid works

This page

APCM

G0556 · G0557 · G0558

Billed by
The patient’s primary care provider
Paid by
Medicare
Paid for
A month of care management, no minutes counted
Care delivered by
The provider’s care team, under their supervision
See the three tiers

The three codes

Review the APCM billing level for each patient

APCM is not billed by the minute. The tier depends on how many chronic conditions the patient has, and whether they are a Qualified Medicare Beneficiary (QMB): someone Medicaid helps pay Medicare costs for.

  1. Level 1

    G0556

    None or one chronic condition

    Any Medicare patient

    $16.37

    per patient, per month · 2026

  2. Level 2

    G0557

    Two or more chronic conditions

    Any Medicare patient

    $53.78

    per patient, per month · 2026

  3. Dual-eligible patients

    Level 3

    G0558

    Two or more chronic conditions

    QMB required

    $117.24

    per patient, per month · 2026

National Medicare amounts per patient per month for 2026, non-facility, before the local adjustment. A chronic condition here is one expected to last at least 12 months that puts the patient at significant risk.

New in 2026

Behavioral health add-ons

Billed with APCM by the same provider, no minutes counted.

  • G0568$161.66

    Collaborative care, first month

  • G0569$145.96

    Collaborative care, later months

  • G0570$57.78

    Behavioral health integration

  • Consent first

    Verbal or written, recorded once. Tell the patient only one provider can bill it each month, that they can stop at any time, and that cost sharing may apply. A patient moving from CCM needs a new consent.

  • Patient cost

    The usual 20% Part B coinsurance applies after the deductible. Qualified Medicare Beneficiaries cannot be billed Medicare cost sharing.

  • Who can bill

    A physician, NP, PA, clinical nurse specialist or certified nurse midwife responsible for all of the patient’s primary care. FQHCs and rural health clinics can bill it too.

See APCM on a sample chart

Billed together

APCM and RPM, in the same month

APCM replaces some programs and sits alongside others. Remote patient monitoring stays separately billable, even by the provider who bills APCM.

APCM
  • RPMRemote patient monitoring, billable
  • RTMRemote therapeutic monitoring, billable
  • BHIBehavioral health and collaborative care, billable
  • CHIPINCommunity health and illness navigation, billable
  • SDOHSocial needs screening, billable

Billable even by the provider who bills APCM, when each service’s rules are met and no time is counted twice.

  • CCMChronic care management, included in APCM
  • PCMPrincipal care management, included in APCM
  • TCMTransitional care management, included in APCM
APCMincludes these

CCM held · APCM active

  • E-visitsVirtual check-ins and e-visits, included in APCM
  • ConsultsImage review and consult requests, included in APCM

Another providercheck CMS and MAC rules

APCM already covers these for the provider who bills it. Other-practitioner billing requires review of current CMS and MAC rules.

APCMG0557
  • 99454RPM device, 16+ days, billed
  • 99457RPM management, 20 min, billed
  • 99490CCM, held this month, held this month

October · sample patient

Hypertension and diabetes, blood pressure cuff at home

APCM consent on file

  • G0557APCM, Level 2Billed
  • 99454RPM device, 16+ daysBilled
  • 99457RPM management, 20 minBilled
  • 99490CCMHeld

3 codes billed · 1 held

This example shows APCM and RPM billed in the same month, with CCM excluded for the provider billing APCM.

An illustration of how the rules combine, not billing advice. Confirm codes with your billing team and your Medicare Administrative Contractor.

How the platform holds CCM in APCM monthsAsk about a patient

Coming from CCM

APCM vs. CCM

Most practices know chronic care management first. Compare CCM time tracking with APCM monthly care-management requirements.

CCM · 99490

Counts minutes

Minutes this month

020 of 20 min

  • 6 minCheck-in call
  • 8 minCare plan update
  • 6 minMedication review

Billable only after 20 minutes are logged

APCM · G0557

No minimum time

October

  • 3Care plan updated
  • 9Discharge follow-up
  • 14Secure message
  • 24Medication review

One code a month, no minutes counted

Sample month for illustration.

What else changes

  • CodesCCM: 99490, 99439, 99487, 99491APCM: G0556, G0557 or G0558
  • What sets the paymentCCM: Minutes loggedAPCM: Chronic conditions and QMB status
  • Who bills itCCM: Any provider managing the conditionsAPCM: Only the provider responsible for all primary care
  • ConsentCCM: RequiredAPCM: Required, and new even after CCM
  • Behavioral healthCCM: BHI billed by the minuteAPCM: Add-ons G0568–G0570, no minutes

Same in both: billed once a monthMedicare rules as of 2026. The same provider cannot bill both for one patient in one month.

Moving patients from CCM? Talk to us

What Medicare asks for

Track APCM service requirements

Delivered as each patient needs them. The practice must be ready for all ten.

  • Once· 2
  • Every month· 4
  • Always on· 3
  • Each year· 1

  1. Consent

    Recorded once, at the start

    Once

  2. First visit

    Unless recent practice visits or care management meet CMS exceptions

    Once

  3. Care management

    Needs, prevention and medications

    Monthly

  4. Care plan

    Electronic, shared with the patient

    Monthly

  5. Transitions

    Follow-up within 7 days, when possible

    Monthly

  6. Coordination

    With home health and hospitals

    Monthly

  7. Messaging

    Portal, check-ins and e-visits

    Always

  8. 24/7 access

    Urgent help at any hour

    AlwaysYour practice

  9. Population health

    Group patients by care needs and risk

    Always

  10. Quality reporting

    Value in Primary Care MVP

    YearlyYour practice

Want to see which of these RemoteCares handles for your team?

Walk through it on a demo

Questions

What people ask about APCM

Not on the list?

Ask us about a patient
  1. 01What is APCM?

    A monthly Medicare care-management payment. Advanced Primary Care Management is a set of three Medicare codes, G0556, G0557 and G0558, that pay a primary care provider each month for managing a patient’s care. It started in January 2025 and has no minimum time.

  2. 02Can a home health agency bill APCM?

    No. APCM is billed by the patient’s primary care provider, or by an FQHC or rural health clinic. The agency coordinates with that provider and bills its own programs, such as S9110 for Texas Medicaid.

  3. 03Does Texas Medicaid pay for APCM?

    No, it is a Medicare benefit. The APCM codes are not on the Texas Medicaid fee schedules. For a patient covered by both programs, Medicare pays the provider for APCM.

  4. 04Can APCM and RPM be billed in the same month?

    Yes. Medicare lets the same provider bill APCM and remote patient monitoring for the same patient in the same month, as long as each service’s own rules are met and no time is counted twice. It has been allowed since APCM began in 2025.

  5. 05What cannot be billed with APCM?

    CCM, PCM and TCM, among others. The provider billing APCM cannot also bill chronic or principal care management, transitional care management, virtual check-ins, e-visits, remote image review or consult requests for that patient that month. Do not assume that changing the billing provider makes overlapping services payable; verify current CMS and MAC instructions.

  6. 06How much does APCM pay in 2026?

    About $16 to $117 a month. National non-facility amounts per patient per month. The amount in your area is adjusted for local costs.

    G0556
    $16.37 · none or one chronic condition
    G0557
    $53.78 · two or more chronic conditions
    G0558
    $117.24 · two or more chronic conditions, QMB
  7. 07Is there a time requirement?

    No. APCM is not time-based. The provider’s team delivers what the patient needs that month, and the practice must be able to deliver every required service.

  8. 08Does the patient pay anything?

    Usually 20% coinsurance. Part B cost sharing applies after the deductible. Qualified Medicare Beneficiaries cannot be billed Medicare cost sharing.

  9. 09What consent does APCM need?

    Verbal or written, once. Explain the service, that only one provider can bill it each month, that the patient can stop at any time and that cost sharing may apply, then record the consent. A patient moving from CCM needs a new consent.

  10. 10Can FQHCs and rural health clinics bill APCM?

    Yes. They bill G0556 to G0558 directly, paid on top of their usual visit payment, and the behavioral health add-ons since 2026.

Where to go next

General information about Medicare APCM as of 2026, not billing or legal advice. Verify current rules with CMS and your Medicare Administrative Contractor.

Run APCM next to RPM Medicaid

Twenty minutes with whoever runs care management and whoever handles billing. We will open a sample chart and walk both programs side by side.

Request a demoHow RPM Medicaid works

If APCM is not a fit for your patients, we will say so on the call.