In the early 2010’s the patient-centered medical home (PCMH) model took root in primary care practices across Michigan. Over time, the model evolved to recognize the importance of team-based approaches, health-related social needs and addressing behavioral health.
Then in 2021, the National Academy of Science, Engineering, and Medicine published Implementing High-Quality Primary Care, which emphasized paying primary care practices more, and paying them differently. Better-resourced primary care practices, in turn, are better able to be proactive in partnering with patients to ensure that needed preventive services are received and that patients are better equipped and more successful in lifestyle change and chronic disease self-management. They are also able to work together to better serve patient needs in a timely and comprehensive way.
In 2025, CMS took the important step of introducing Advanced Primary Care Management (APCM) codes to fuel this delivery of comprehensive, continuous, coordinated primary care described in the 2021 NASEM report.
The APCM codes are structured to promote longitudinal, relationship-based care. What makes the APCM codes so important is that unlike so many others, they are specific to those “who are responsible for all of a patient’s primary care services and serves as the focal point for a patient’s needed health care services.” Primary care is even imbued in the name of the code set (Advanced Primary Care Management codes).
There are three CMS APCM codes (G0556, G0557, and G0558) that vary by patient complexity, from no chronic illness to two or more chronic illnesses. CMS has a helpful APCM services explainer FAQ to support practices in implementation and provision of APCM.
The CMS APCM codes bundle thirteen service elements into a single monthly payment. These service elements include: patient consent, an initiating visit, 24/7 access to care, continuity of care, comprehensive care management, care plan creation and revision, management of care transitions, coordination with community-based services, ongoing patient communication, enhanced communication using health IT, population-level data analysis, risk stratification, and performance measurement. Note that these services are not expected to be delivered each month that the code is billed; however, practices must be capable of delivering all 13 and providing them as appropriate for the patient.
The codes under the Traditional Medicare benefit structure have the customary 20% patient-cost share. Most Traditional Medicare beneficiaries have a supplemental policy that would cover the cost-share, a small portion do not. This exposes this small set of patients to financial liability for care management, severely limiting the uptake of APCM codes more broadly. Key national groups like the Primary Care Collaborative are working to free APCM codes from patient financial liability to overcome this barrier. The
2026 Evidence Report, the Primary Care Collaborative dives into the current state of APCM adoption; what factors are driving adoption; what challenges early adopters have faced; and how the primary care community perceives CMS’s latest effort to address chronic conditions. For those who are interested, on October 29th at 1:30pm ET, they will present their newest Evidence Report Release – APCM: Ensuring it Delivers Better Health.
There is national legislation that has been introduced as well to spur implementation of advanced primary care models by better resourcing primary care practices including the Patients First Act (H.R. 9693) and Pay PCPs Act of 2026 (S.B. 5269). We will continue to watch their progress in 2027.
