Carematix solutions by program
Advanced Primary
Care Management
Support comprehensive, ongoing care without monthly time-tracking requirements. APCM provides a monthly care-management framework with payment tiers based on patient complexity and qualifying Medicare status.
A Shift Beyond Time-Based Care Management
CMS introduced APCM to support comprehensive, ongoing primary care through a monthly payment structure that is based on patient complexity rather than accumulated staff time. Practices must meet applicable patient eligibility, service, access, documentation, and billing requirements.
No Monthly Time Threshold
Unlike time-based CCM codes, APCM does not require practices to document a minimum number of care-management minutes each month.
Complexity-Based
APCM includes three monthly billing codes—G0556, G0557, and G0558—based on the patient’s number of chronic conditions and, for the highest level, QMB status.
Billable with RPM
Patients may be enrolled in both APCM and RPM and practices can bill for both services in the same month. These codes are intended to support ongoing longitudinal care.
Comprehensive Ongoing Care
APCM supports ongoing primary care through care planning, care coordination, enhanced access, transitional care, and population-health management between scheduled visits.
Combine RPM and APCM Billing in the Same Month
RPM and APCM may be billed for the same patient during the same month when the requirements for each service are independently met. APCM supports longitudinal primary care, while RPM separately covers connected-device data collection and treatment management. The appropriate APCM level is selected based on the patient's chronic conditions and Medicare status, not time spent.
APCM Level 2
Monthly APCM services for a patient with two or more chronic conditions, provided under the direction of the patient's primary care provider.
Care plan on file and updated as medically necessary. Billed under primary care provider.
Published guide amounts and service requirements can vary by payer, locality, and program setup. Confirm current billing requirements with your compliance and revenue-cycle teams before submitting claims.
Estimate Your Annual Revenue Opportunity
See how a practice-owned RPM and APCM program could support proactive patient care while creating a sustainable new revenue opportunity. Adjust the number of eligible Medicare patients in your practice to explore estimated annual reimbursement.
Annual Revenue
99458
G0557
G0558