A new Medicare reimbursement framework for primary care
$67 PMPM: G0558 base rate for Advanced Primary Care Management, per the CMS Physician Fee Schedule 2026 Final Rule.
APCM is a CMS care-management framework that primary care practices bill under their own TIN. The 2026 PFS rule introduced base rate increases and three new behavioral health add-on codes — making 2026 the first year the program is meaningful at scale.
Editorial coverage of the Advanced Primary Care Management program for primary care practices.
What APCM is
Advanced Primary Care Management (APCM) is a Medicare reimbursement framework codified under HCPCS codes G0556, G0557, and G0558. It pays primary care practices on a per-beneficiary, per-month basis for care-management activities provided to attributed Medicare patients. Unlike Chronic Care Management (CCM), APCM does not require a minimum time threshold per month — payment is structured around patient complexity tiers rather than minutes logged (CMS PFS 2026 Final Rule; see also AAFP coverage of APCM).
2026 is the inflection year. The PFS Final Rule raised the base PMPM rates across G0556–G0558 and introduced three behavioral health add-on codes — G0568, G0569, and G0570 — that allow practices to layer behavioral health integration on top of the APCM base. The add-on codes are billed by the primary care practice under the same TIN as the base codes, in the same calendar month (CMS PFS 2026 Final Rule).
The model that makes this operationally viable for most primary care practices is partner-led. The practice bills Medicare directly for APCM base and BH add-on codes under its own TIN. A behavioral health partner provides the clinical infrastructure — behavioral health care manager (BHCM), psychiatric consultant, validated screening protocols, and patient registry — under a fixed Fair Market Value Management Services Agreement. The partner is paid a flat FMV fee for clinical services rendered; the practice’s Medicare reimbursement is the practice’s revenue. This structure parallels the Concert Health Model B arrangement that has been deployed across hundreds of primary care practices for Collaborative Care Management.
APCM is designed for primary care practices with a meaningful Medicare panel: independent primary care practices, multi-specialty groups with a primary care line, FQHCs and rural health clinics, and ACO or MSO networks operating across multiple TINs. Practices with fewer than ~2,000 Medicare-attributed beneficiaries may find the operational overhead difficult to justify against the reimbursement; practices above that threshold typically have the panel depth to make implementation meaningful.
Where to start
The APCM Opportunity
Why the 2026 PFS Final Rule changes the economics of primary care management — and what's different about the behavioral health add-on codes.
Read → ComparisonAPCM vs. CCM
How the new framework differs from Chronic Care Management on payment structure, time thresholds, and eligible patient population.
Read → ReimbursementAPCM Reimbursement in 2026
The base PMPM rates across G0556–G0558 and the BH add-on codes G0568–G0570, with citations to the CMS PFS Final Rule.
Read → Fit assessmentDoes APCM Fit Your Practice?
Panel size, EHR capability, care-management infrastructure, and the questions to ask before evaluating a partner.
Read →Talk to an implementation partner
APCM requires clinical infrastructure that most primary care practices don’t carry in-house: care management staffing, psychiatric consultation, validated screening protocols, and a longitudinal patient registry. An implementation partner handles that infrastructure under a fixed FMV Management Services Agreement and assesses whether the program is a fit for your practice before either side commits.
For background on our editorial approach and source standards, see methodology and about.