Federally Qualified Health Centers (FQHCs) provide care that continues after patients leave the building. Medication questions, specialist referrals and follow-up after a hospital discharge all need attention between appointments. That work needs a way to be delivered consistently and reimbursed.

Advanced Primary Care Management (APCM) gives FQHCs a monthly reimbursement model for comprehensive primary care management. CMS reimburses eligible services separately from the FQHC Prospective Payment System (PPS), without a monthly time threshold.

For health centers, the opportunity is to support continuous care with a recurring reimbursement model. Actuvi provides the software, implementation and training to help clinics run the program, while their care teams remain responsible for patient care.

How are FQHCs reimbursed for APCM?

FQHCs bill APCM directly using HCPCS codes G0556, G0557 or G0558. CMS reimburses these services at the national non-facility Physician Fee Schedule rate, in addition to PPS reimbursements. A qualifying visit is not required in the same month for separate APCM reimbursement.

APCM can be billed once per patient per calendar month when the applicable requirements are met. The code depends on the patient's medical and social complexity:

• G0556: The base level of APCM, including patients with no chronic conditions or one chronic condition.

• G0557: Patients with two or more chronic conditions expected to last at least 12 months, or until death, that place them at significant risk of death, acute deterioration or functional decline.

• G0558: Patients who meet the G0557 condition criteria and are Qualified Medicare Beneficiaries (QMBs).

Low income alone does not establish eligibility for G0558. QMB status and the clinical criteria both matter. Reimbursements also depend on eligible enrollment and meeting the service requirements, so total patient count should not be treated as billable APCM volume.

What does APCM cover between visits?

APCM combines elements of care management and communication services into a monthly bundle. It supports ongoing primary care rather than a separate claim for each included activity.

The requirements include 24/7 access for urgent needs, continuity with a designated care team, medication management and an electronic patient-centered care plan. Care transitions, coordination with specialists and community services, and digital communication are also part of the model.

These requirements fit the work health centers deliver across medical and social needs. A referral may need follow-up. A change in medication may need clarification. A discharge may require coordination with another care setting. APCM provides a framework for keeping that care connected.

CMS does not require every service element to be delivered to every patient each month. Services follow individual need and medical necessity, but the required capabilities must be available.

No monthly time threshold still means care requirements

Unlike time-based care management codes, APCM does not require a minimum number of minutes each month. That removes time-based reimbursement as the basis for APCM billing.

Consent, appropriate service delivery and documentation remain necessary. Patients must understand that only one provider can furnish and receive reimbursements for APCM in a calendar month, that they can stop services, and that cost sharing may apply. An initiating visit is required when applicable.

FQHCs also have a specific distinction: those not eligible for MIPS are not required to report the Value in Primary Care MIPS Value Pathway to meet the performance measurement requirement. A general primary care billing guide should not be applied to health centers without checking these differences.

How Actuvi supports APCM across health-center locations

Actuvi supports APCM with care plans, patient communication, alerts and reporting on one platform. Patients use the app to connect with their care team, access their data and receive reminders. Care teams see patient activity, alerts and progress over time.

Actuvi builds the program and organization on the platform, helps prepare care plans, and trains administrative, clinical and billing teams. Ongoing support and program reports help teams review how the program is running.

For groups with several locations, monitoring can stay with each site's care team or be handled centrally. Actuvi works through the workflows and staff roles during implementation, rather than leaving every location to assemble a separate program.

Clinical responsibility stays with the health center. Actuvi implements the program and trains the team; the care team monitors patients and responds to their needs. Software supports the work but does not replace the people or coverage arrangements required to deliver it.

A recurring model for continuous primary care

APCM gives FQHCs a way to connect ongoing primary care with monthly reimbursements beyond the encounter. The financial opportunity rests on a working care program: eligible patients, continuity, documented services and a team able to respond.

Actuvi brings the technology and implementation together so health centers can run that program across their clinics, with care staying connected to their own teams.

Talk to Actuvi about APCM for your health centers.