When CMS debuted the new advanced primary care management (APCM) codes on Jan. 1, 2025, practices were excited about the prospect of collecting more for value-based care. By improving patient outcomes and reducing costs, you can have healthier patients and bring in more reimbursement — if you know how to report G0556-G0558.

Check out three tips that will help you get paid for the new APCM codes that Medicare payers began accepting this year.

1. You Must Have Documented Consent

Before you begin performing APCM services, you need to get consent from the patient, and then you must document that consent in the record. There’s no need to do this every time you’re billing an APCM service, but it must happen the first time.

One reason this is important is because only one provider can collect for APCM services in a particular month. The payments you receive for G0556-G0558 cover your care as the patient’s primary care physician — meaning you’re the patient’s main focal point for medical services. Since two doctors can’t be the main focal point, Medicare only pays one provider for these codes monthly. Getting the patient’s consent is one way you can confirm that no one else is that patient’s focal point for primary care services.

2. An Initiating Visit Must Precede APCM

When you see a new patient, you must first perform a separately billable initiating visit before you can start billing APCM. If the payer sees that you’ve reported an APCM code for a new patient without another visit first, your APCM claim may be denied.

There are a few exceptions to this rule. You don’t need to conduct an initiating visit if:

• You or another provider at your practice saw the patient within the past three years
• You or another provider at the same practice performed a different care management service for that patient within the past year (care management services include CCM, PCM, or APCM)

Keep in mind that annual wellness visits (AWVs) can qualify as an initiating visit.

3. You Must Field Urgent, 24/7 Needs

To collect for APCM services, you’ll need to provide round-the-clock, 24/7 access to your patients or their caregivers if they have urgent needs. You’ll also need to be able to access their medical information in real time at all hours. In some cases, this will mean you’ll need to be able to see patients after hours or at their homes.