CMS APCM Codes 2025 – A New Era in Remote Care for FQHCs and RHCs

The Centers for Medicare & Medicaid Services (CMS) is reshaping healthcare delivery in 2025 with the introduction of Advanced Primary Care Management (APCM) codes—a major step forward for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).

These new codes simplify billing and encourage adoption of value-based, remote-first care models, aligning well with innovations like Remote Patient Monitoring (RPM) and Chronic Care Management (CCM).

What This Blog Covers

• Overview of the new APCM codes
• How they enable remote care
• Benefits for providers and patients
• Reimbursement and billing details
• Implementation challenges and strategies

What Are the New APCM Codes?

APCM codes are designed to reimburse providers for managing the full scope of a patient’s condition—not just in the clinic, but remotely. They streamline billing by combining elements of existing care management codes, such as:

• Principal Care Management (PCM)
• Chronic Care Management (CCM)
• Transitional Care Management (TCM)

Code Levels & Reimbursement

| Code | Use Case | Rate (Monthly) | | --- | --- | --- | | G0556 | One chronic condition | $15.20 | | G0557 | Two or more chronic conditions | $48.84 | | G0558 | Two+ chronic conditions + QMB | $107.07 |

The codes support services like:

• Risk stratification
• Population health analysis
• Care coordination
• Patient-centered management

They help reduce administrative burden by combining multiple services into one code—while still allowing concurrent billing with RPM (but not CCM).

Supporting Remote Care

The APCM codes expand how care can be delivered by allowing reimbursement for:

• Phone and video visits
• Telehealth-based follow-ups and education
• Medication management done remotely
• Behind-the-scenes provider work (chart reviews, consults, etc.)

This enables proactive intervention, aligns with value-based care, and helps prevent unnecessary ER visits or hospitalizations.

Impact on Providers & Patients

For Providers:

• Simplified Billing: One monthly code instead of several
• Less Admin Work: Streamlined documentation
• Better Collaboration: Encourages team-based care
• Improved Telehealth Access: Virtual care becomes easier to deliver
• Value-Based Focus: Rewards quality over quantity

For Patients:

• More Convenient Access: Remote consultations via phone, video, or text
• Improved Coordination: Unified care plans that reduce confusion
• Personalized Plans: Tailored to individual health needs
• Lower Costs: Fewer ER visits and better prevention

Billing and Reimbursement Highlights

• Monthly Billing per patient, per calendar month
• Consent Required: Patients must agree (verbal or written)
• 24/7 Access: Practices must offer emergency contact pathways
• Care Plan Needed: Must be electronic, shared, and regularly updated
• Continuity of Care: Same care team should manage the patient
• No CCM Double-Billing: But RPM is allowed concurrently

💡 Use the CMS Physician Fee Schedule Tool to verify region-specific rates.

Challenges & Solutions

Common Barriers:

• Workflow and staffing changes
• EHR upgrades for care plan management
• Training for telehealth tools
• Data privacy and interoperability
• Patient education and onboarding

Implementation Tips:

• Gap Analysis: Identify where your practice falls short
• EHR Setup: Ensure care plan, telehealth, and RPM integration
• Train Your Team: On coding, documentation, and patient support
• Patient Engagement: Use email, mailers, in-office brochures
• Track Outcomes: Use data to adjust workflows and improve results

Remote Care is the Future

The rollout of CMS APCM codes in 2025 marks a milestone in remote care evolution. By making value-based, patient-centered care more accessible and billable, FQHCs and RHCs can lead the charge toward better outcomes and smarter workflows.

Want to learn how to implement RPM and CCM alongside APCM for your practice? Schedule a meeting with our experts today!