CMS Introduces New APCM Codes to Enhance Remote Care in 2025

The Centers for Medicare & Medicaid Services (CMS) is shaping the future with the introduction of new Advanced Primary Care Management (APCM) codes and service-based billing codes for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).

These new codes mark another step forward in the evolution of remote care. 

Every year, it is easier for healthcare providers to deliver high-quality, reimbursable care while enhancing patient access. This blog serves as your guide to understanding these new codes and how they benefit both healthcare providers and patients.

We will cover:

• The New APCM Codes
• How They Support Remote Care
• The Impact of Patients & Providers
• Reimbursement Considerations
• Challenges with Implementation

Overview of the New APCM Codes

APCM codes are a new set of billing codes designed to help healthcare providers receive Medicare reimbursement for delivering advanced primary care management services—a practice method focused on allowing physicians the time they need to treat the full scope of a patient’s condition. These codes balance a simplified billing process with expanded access to remote care.

The new APCM billing codes incorporate key elements from existing CMS-defined services, including Principal Care Management (PCM), Chronic Care Management (CCM), and Transitional Care Management (TCM). They are structured into three levels, each corresponding to the complexity of the patient’s condition.

CMS is introducing new APCM services to streamline billing and lessen administrative strain. These services include:

• Risk stratification evaluations
• Practice population analysis 
• Care coordination strategies
• Patient-centric care management

Instead of using physicians' time for care management, they allow practices to customize services according to patient needs. Complementary services may be invoiced concurrently, however services that overlap with APCM are not billed in the same period.

How the New APCM Codes Support Remote Care

Remote care has been reshaping how patients can access medical care, and the new APCM codes are making it even easier. The codes cover things like making a complete care plan for the patient, allowing adjacent specialties to work together, educating patients about their conditions (and how to treat them), and managing chronic or comorbid conditions like diabetes and hypertension. 

Here is how the new APCM codes support remote care:

1. Healthcare providers can now offer care through telehealth services, including phone and video visits.
2. Follow-ups, medication management, and care coordination can all happen remotely. 
3. Patients don’t have to wait for in-person visits to get the help they need sooner, which reduces unnecessary ER visits or hospitalizations.
4. The behind-the-scenes work of doctors, such as reviewing patient data or consulting with other providers, will now be billable. 

Thanks to these new codes, doctors can align their practices with value-based care (VBC) models that support their focus on patient care without being so pressed for time. The codes also encourage a proactive attitude, helping healthcare professionals spot health issues early, before they get worse. 

Impact on Healthcare Providers and Patients

Here is how the new APCM codes in 2025 impact patients and providers: 

Streamlined Billing and Reduced Administrative Burden

Multiple care management services are consolidated into a single billing code by APCM. This significantly simplifies remote care billing, saving time and effort spent juggling several codes and restrictions.

Increased Focus on Value-Based Care

Providers are urged by APCM to prioritize care quality over service volume. This shift toward value-based care encourages physicians to concentrate on chronic illness management, preventative care, and care coordination, leading to better patient outcomes.   

Enhanced Care Coordination

APCM encourages healthcare professionals to collaborate. Providers are urged to work together with nurses, specialists, and other members of the care team to deliver comprehensive care to patients.

Greater Flexibility in Care Delivery

APCM facilitates the delivery of telehealth services, including virtual check-ins, telehealth consultations, and remote patient monitoring (RPM). This enhances patient access to care, particularly for those in remote locations or with mobility issues.  

For Patients

CMS's 2025 implementation of Advanced Primary Care Management (APCM) codes is expected to have a major positive impact on patients in a number of ways. They include:

Improved Access to Care

One of the most important aspects of remote care is increased patient access. Now with APCM codes, it is easier for healthcare providers to bill for remote care services. This implies that patients can get high-quality care—from your clinicians—in the comfort of their own homes.

This is particularly beneficial for those living in remote areas or facing mobility challenges. Through encrypted texting, phone calls, or telehealth, patients can communicate with their healthcare providers, saving time and easing the strain of travel.

Improved Care Coordination

APCM codes encourage a complete approach to care. Providers are encouraged to consider the patient's general health rather than simply specific symptoms. This results in better chronic condition management and preventive treatment.

Patient satisfaction can also be improved. One of the worst parts of managing chronic conditions is the lack of coordination that often occurs. APCM codes help reduce the potential for confusion.

More Personalized Care

Using APCM, providers can create customized care plans, taking into account each patient's particular requirements and circumstances. This indicates that patients are more likely to follow their care regimens and that treatment is more effective.  

Reduced Healthcare Costs

APCM can help reduce the need for expensive hospital stays and ER visits systematically by emphasizing early intervention and preventative treatment.   

Reimbursement and Billing Considerations

Here's a breakdown of the most crucial points:

APCM Codes and Their Corresponding Reimbursements

Medicare may receive APCM service bills from providers once a month for each qualified patient. The level of the code determines the payment amount.

• G0556: $15.20 per patient per month.
• G0557: $48.84 per patient per month.
• G0558: $107.07 per patient per month.

Note: These are averages for the entire country. Geographical location and other variables may have an impact on the actual reimbursement amounts. Providers must use the CMS website's Physician Fee Schedule lookup tool to verify the precise rates for their region. 

Key Billing Requirements

• Patient Consent: To receive APCM services, providers need the patient's verbal or written agreement. Information on the program, any cost-sharing, and the patient's ability to discontinue treatment at any time should all be included in this consent, which should be recorded in the patient's medical file.
• Qualifying Visit: Initiating APCM services during a qualifying visit is required for new patients or patients who have not been seen in the previous three years.
• 24/7 Access: In the event of an emergency, providers must guarantee that patients can reach the care team at any time. This entails giving patients a method to get in touch with the practice's medical staff whenever they choose.
• Continuity of Care: To guarantee continuity of treatment, patients should be able to make regular appointments with a specific member of the care team.
• Care Plan: An electronic, patient-centered comprehensive care plan must be created, implemented, and maintained by the providers. The patient and every member of the care team should have access to this plan, which should also be updated on a regular basis.
• Care Coordination: Because APCM places a strong emphasis on care coordination, clinicians must record their attempts to coordinate treatment across various venues and healthcare providers.

Billing Frequency

Once per patient every calendar month, providers are permitted to bill for APCM services. In contrast to the time-based restrictions of several other care management codes, this streamlines billing. 

Concurrent Billing

Chronic Care Management (CCM) services cannot be billed alongside APCM. To further improve the possibilities of remote care, it can be invoiced in conjunction with Remote Patient Monitoring (RPM) services. 

Challenges and Implementation Strategies

Now, let’s be realistic and discuss the different challenges and implementation strategies/solutions for APCM codes 2025. 

Challenges

• APCM frequently necessitates a change in practice operations. This could entail personnel training, technological advancements, and modifications to process.
• Patients must be aware of the advantages of APCM as well as how to use telehealth and remote monitoring services. When using technology for remote treatment, certain patients might require assistance.
• Ensuring the smooth transfer of patient data while upholding security and privacy.
• Putting in place mechanisms to monitor patient results and show how well APCM services work. Maintaining current knowledge of CMS reporting requirements and making sure that data is submitted accurately.
• It can be necessary for practices to make workflow modifications, staff training investments, and technological investments. 

Implementation Strategies

• Determine the gaps in the current practice's capabilities, and how much these gaps affect the patient population. With very specific goals, deadlines, and roles, come up with a solid implementation strategy.
• Check that the EHR system can meet the needs of APCM such as setting up care plans, data sharing and reporting. Create a simple-to-use telehealth platform to monitor and consult telehealth from afar.
• After, train employees on technology use, care coordination methods, billing practices, and APCM requirements.
• Provide assistance to staff members with questions or problems by offering resources and continuing assisting. 
  Inform patients on the various platforms (e.g., mail, email, phone calls, in-office materials) of the benefits of using APCM. Provide assistance in the remote treatment of patients who need support to do so via technology.
• Lines of communication should be clear and communication among providers, experts, and other members of the care team added to that.
• The mechanisms should also be put in place to monitor patient outcomes and use data analysis to identify those areas that require improvement.
• Regularly track APCM performance indicators to maximize APCM services, and adjust as needed.
• See that employees understand coding standards and APCM billing procedures. 

Remote Care is the Future

Patients should speak with their physician if they would like to receive APCM services. Their physician can establish whether they qualify for the treatments and create a personalized care plan.

A new era in remote care is here with the introduction of APCM codes by CMS in 2025. These new codes simplify billing while emphasizing value-based care and care coordination. The result is improved patient outcomes and a more streamlined approach for providers to deliver high-quality care. APCM codes are at the forefront of how remote care will continue to evolve, and healthcare as a whole.

The introduction of APCM codes is a significant moment in the development of remote care. These codes ensure that patients can receive the best quality care from the comfort of their own homes. With the technology advancing so quickly, we can only guess how much more advanced the field of remote care will become in the coming years.

Want to learn more about implementing RPM & CCM? Schedule a meeting today!