Navigating APCM billing: What to know about G0556, G0557 and G0558 CPT Codes

Note: Only one APCM code can be billed per patient per month. If patient eligibility changes, the billing code must be updated accordingly.

APCM Service Requirements for Billing

Practices don’t need to deliver every service each month, but must be able to offer all core components below.

1. Patient Consent and Enrollment

• Obtain and document patient consent
• Ensure patients understand participation terms and cost sharing
• Initiate during a qualifying visit (if not seen in the last 3 years)

2. 24/7 Access to Care

• Offer patients round-the-clock access to care coordination and support
• Include after-hours and weekend availability for urgent needs

3. Comprehensive Care Planning

• Perform medical and psychosocial assessments
• Develop and maintain an electronic, patient-centered care plan
• Share the plan with the care team and patient

4. Care Coordination and Transitions

• Manage communication with hospitals, specialists, and post-acute facilities
• Ensure follow-up within 7 days of discharge
• Facilitate timely information exchange and referrals

5. Medication and Preventive Care Management

• Perform medication reconciliation and support adherence
• Monitor preventive care delivery using system-based tools

6. Digital Communication and Patient Engagement

• Provide secure messaging and portal access for non-face-to-face communication
• Support asynchronous check-ins and virtual care options

7. Population Health and Reporting

• Stratify patients based on risk and care needs
• Use analytics to identify care gaps
• Support participation in quality measurement programs when applicable

Who Can Bill for APCM Services

Eligible providers include:

• Physicians
• Nurse Practitioners
• Physician Assistants

To bill APCM, these practitioners must oversee all primary care for the patient and provide general supervision to clinical staff delivering the service.

Want to learn how Medsien’s care team supports this delivery on your behalf? Explore how we staff your APCM program.

Why Practices Trust Medsien for APCM Success

Unlike self-managed care models or fragmented platforms, Medsien offers:

• A fully managed APCM program from onboarding to billing
  
  
• AI-powered eligibility identification
  
  
• Dedicated care team to handle monthly outreach and care plan tasks
  
  
• Real-time dashboards for compliance and reimbursement tracking
  
  
• CMS-aligned billing workflows ready out of the box

Whether you're launching APCM for the first time or scaling an existing care program, Medsien simplifies it all.

Ready to Launch and Bill for APCM?

APCM is a major step forward for proactive patient care—and a powerful new revenue stream for clinics. But billing and service delivery must be precise and compliant.

• Let Medsien guide your team through the entire process
• Meet all CMS requirements with zero administrative burden
• Unlock sustainable monthly revenue

Schedule your APCM demo now to see how we help you launch and bill confidently from day one.