Advanced Primary Care Management
APCM is a CMS program that reimburses clinics monthly for comprehensive primary care management of Medicare patients, across three tiers set by complexity.
It bundles covered care-management services into one monthly code per patient, without time tracking requirements.
Who can bill APCM, and for which patients
Physicians, nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists who are responsible for all of the patient's primary care. Only one practitioner can bill APCM for a patient each month.
Medicare Part B patients who consent to APCM. A patient's tier depends on how many chronic conditions they have and whether they are a Qualified Medicare Beneficiary (QMB).
APCM reimbursements
CMS reimburses APCM once a month for each patient, based on their tier.
| Tier | Who qualifies | Code | Monthly reimbursement per patient |
|---|---|---|---|
| Level 3High complexity | QMB with 2 or more chronic conditions | G0558 | $117.24 |
| Level 2Moderate complexity | 2 or more chronic conditions | G0557 | $53.78 |
| Level 1Low complexity | 0 or 1 chronic condition | G0556 | $16.37 |
2026 national non-facility rates. Reimbursement varies by locality. Source: CMS 2026 Physician Fee Schedule.
Qualifying chronic conditions are expected to last at least 12 months or until death, and place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
Unlike CCM, APCM has no time tracking requirements.
A QMB patient with 2 or more chronic conditions is billed under G0558 at $117.24 a month, more than twice the G0557 rate. QMB patients also cannot be billed for APCM coinsurance.
Reimbursements for 1,000 patients
| Tier | Monthly, for 1,000 patients | Annual, for 1,000 patients |
|---|---|---|
| Level 3 (G0558) | $117,240 | $1,406,880 |
| Level 2 (G0557) | $53,780 | $645,360 |
| Level 1 (G0556) | $16,370 | $196,440 |
At 2026 national non-facility rates.
What CMS requires, and how Actuvi does it
CMS lists the elements clinics must offer to bill APCM. Not every element has to be delivered every month, but each one has to be available when the patient needs it.
Providers can hold the visit over Actuvi telehealth when the visit type allows it, or in the clinic.
Actuvi sends the consent form automatically, and patients sign it electronically on the Actuvi platform.
Actuvi gives patients access to their care team through the app at any time. Each patient has a designated care team, and after-hours teams can be added.
Actuvi enrolls each patient in a care management plan that collects their data, including symptoms, treatment response, and medication and therapy adherence, and keeps them connected to the care team.
Actuvi builds the care plans, and care teams can add, remove or edit them on the platform.
Staff can easily change a patient's care plan on Actuvi after a transition, and follow up through the app, messaging or telehealth.
Actuvi moves patient data between systems through EHR and FHIR integration, and Guardian Access keeps caregivers involved.
Actuvi provides secure messaging in the app and on the web, and telehealth visits.
Actuvi stratifies patients and flags who needs attention.
Actuvi tracks the data points clinics choose, charts them, and generates the quality and billing reports.
Behavioral health add-ons
Available from January 1, 2026.
Clinics can add behavioral health integration to APCM with three add-on codes. They apply only when the same practitioner reports an APCM base code that month, and none of them are time based.
| Code | What it covers | Monthly reimbursement per patient |
|---|---|---|
| G0568 | Collaborative Care Model (CoCM), first month. A behavioral health care manager and a psychiatric consultant work with the existing clinical staff. | $161.66 |
| G0569 | Collaborative Care Model (CoCM), each following month. | $145.96 |
| G0570 | General BHI, directed by a physician or other qualified health care professional. | $57.78 |
2026 national non-facility rates. A 20% Part B coinsurance generally applies to BHI services, and QMB patients cannot be billed for Medicare cost sharing. Each add-on has its own clinical, consent and documentation requirements.