Primary care providers will have new options for collecting from Medicare in 2025, thanks to the addition of three new advanced primary care management (APCM) codes (G0556-G0558).
These codes will go into effect on January 1, so now is the time to pinpoint exactly what’s required before you report G0556, G0557 and G0558.
You’ll Report G0556-G0558 Once a Month
The finalized APCM services incorporate elements of several existing care management and communication technology-based services. These will now be bundled into codes that reflect the essential elements of the delivery of advanced primary care, including Principal Care Management, Transitional Care Management, and Chronic Care Management. The code descriptors are as follows:
G0556 — Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month
G0557 — Advanced primary care management services for a patient with multiple [two or more] chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month
G0558 — Advanced primary care management services for a patient that is a Qualified Medicare Beneficiary with multiple [two or more] chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month
Unlike the existing complex care management and principal care management, you won’t need to tally how much time the provider spends before you report these codes. Instead, you’ll report them on a monthly basis to reflect the time that goes into your provider’s primary care services for the patient.
Your Practice Can Report One Per Month, Per Patient
Only one provider at your practice can report a code from the G0556-G0558 series for a patient during a given month. However, the billing provider can be different from one month to the next.
Example: Dr. Smith reports G0556 in July 2025 to reflect the time he spends handling primary care management for Patient Wilson, who has one chronic condition. In August 2025, Dr. Jones bills G0556 for her primary care of Patient Wilson’s one chronic condition. Dr. Smith and Dr. Jones are part of the same practice, but since only one of them is billing G0556 in a single month, the Medicare payer should still reimburse the practice for the care.
You’ll collect about $15 for G0556, about $49 for G0557, and approximately $107 for G0558.
Nonphysician Providers Can Report G0556-G0558
If nurse practitioners (NPs), physician assistants (PAs), certified nurse midwives (CNMs) and clinical nurse specialists (CNSs) are the providers performing the APCM services, they can report the applicable code to the Medicare payer. The provider reporting it does not have to be a physician.
As part of the requirements for reporting G0556-G0558, the practice must perform the following responsibilities, among others:
- Get consent from the patient
- Perform an initiating visit, unless the patient has been seen by the practice in the last three years
- Provide 24/7 access to the care team for urgent care needs
- Offer continuity of care
- Provide comprehensive care management, including preventive care, medication oversight and more
- Maintain an electronic care plan
- Manage any care transitions
- Provide consistent communication
Practices are urged to get a copy of their MAC’s specific local coverage determination for APCM before billing for these services so they know exactly what’s required.
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