Advanced Primary Care Management

Deliver APCM services efficiently and elevate the quality of primary care for your Medicare patients. We enable providers to streamline APCM delivery while optimizing reimbursements.

Schedule A Demo

“133 million Americans—or 40% of the U.S. population—live with at least one chronic disease.”

What is Advanced Primary Care Management?

CMS’ Advanced Primary Care Management (APCM) program integrates care coordination, preventive care, chronic disease management, and patient engagement into a streamlined approach that rewards healthcare providers for delivering high-quality, comprehensive primary care.

APCM services are designed to:

Improve patient outcomes and engagement
Focus on the whole person, not just their symptoms
Build sustained relationships between patients and providers
Extended care beyond traditional office visits

How APCM is different from other Care Management Programs

Advanced Primary Care Management (APCM) differs from other care management programs in several key ways. Here's a breakdown

Coding Based on Patient Risk Stratification, Not Time

Reimbursement and coding are determined by patient risk stratification, focusing on the patient's overall risk profile rather than the time spent on care activities.
No Minimum Time Requirement

Eliminates the need for providers to document a minimum amount of time spent on care. Instead, the focus is on care management activities and measurable outcomes, like improving patient health and preventing hospitalizations.
Broader Eligibility: Not Limited to Chronic Conditions

Designed for all Medicare beneficiaries, regardless of whether they have chronic conditions. It encompasses a wider range of primary care needs, including preventive services, acute care, and behavioral health.
Participation in Quality Measurement

It requires providers to participate in quality measurement programs, aligning care delivery with CMS value-based care initiatives. Success is evaluated based on metrics like improved outcomes, reduced hospitalizations, and patient satisfaction.

Is APCM different from CCM and PCM?

APCM follows its own set of requirements and reimbursement models.

Feature	APCM	CCM	PCM
Focus	Comprehensive, patient-centered primary care	Managing multiple chronic conditions	Managing a single, high-risk condition
Eligibility	All Medicare beneficiaries	Patients with 2+ chronic conditions	Patients with 1 high-risk chronic condition
Reimbursement Basis	Risk stratification, outcomes	Time-based (20+ minutes/month)	Time-based (30+ minutes/month)
Time Documentation	Not required	Required	Required
Care Coordination Scope	Broad (primary, preventive, behavioral)	Chronic conditions	Specific chronic condition

HealthViewX Advanced Primary Care Management

With HealthViewX, healthcare systems can seamlessly implement and manage Advanced Primary Care programs, enabling compliance with CMS guidelines while enhancing care delivery efficiency. Our platform is purpose-built to support healthcare providers in delivering high-quality primary care services that prioritize patient outcomes and reduce administrative burdens.

By partnering with HealthViewX for Advanced Primary Care Management, healthcare systems can better manage the needs of their Medicare patients, achieve regulatory compliance, and drive financial success in a value-based care environment.

Key Features of HealthViewX Advanced Primary Care Management

Comprehensive Program Management
- Streamline patient enrollment and care planning.
- Automate compliance with CMS Advanced Primary Care guidelines.
- Manage care coordination across multidisciplinary teams.
Advanced Reporting and Analytics
- Access detailed program performance reports for CMS submission.
- Track patient progress and key care metrics in real-time.
- Leverage predictive analytics for proactive care management.
Optimized Reimbursements
- Maximize CMS reimbursements through accurate and timely billing.
- Manage multiple care management programs with ease.
- Stay compliant with evolving Medicare Fee Schedule updates.
Scalable and Customizable
- Adapt the platform to the unique needs of your healthcare system.
- Scale effortlessly to accommodate growing patient volumes.
- Customize workflows to align with existing processes.
Integrated Care Delivery
- Enable seamless communication between providers, patients, and care teams.
- Use actionable insights to identify care gaps and improve health outcomes.
- Coordinate services for chronic conditions, preventive care, and behavioral health.

Benefits for Care Practices

Improved Patient Outcomes

Deliver personalized, continuous care to improve patient satisfaction and health outcomes.
Reduced Administrative Burden

Automate routine tasks, allowing care teams to focus on what matters most—patient care.
Enhanced Financial Performance

Drive value-based profitability with optimized reimbursements and reduced readmissions.
Future-Ready Compliance

Stay ahead of regulatory changes with a platform built to evolve with CMS requirements.

CPT Codes & Descriptors:

Coding is based on patient risk stratification and not time. APCM offers three risk-stratified HCPCS codes. The three new codes would include G0556, G0557, and G0558, which the practitioner of record can bill per patient per month.

G0556 is geared toward patients with one or no chronic illness. It covers advanced primary care management services provided by clinical staff directed by a physician or other qualified healthcare professional. This clinician is responsible for delivering ongoing contact for all needed healthcare services. The proposed value for GPCM1 is $10 per patient per month with an RVU value of 0.17.
G0557 includes the basic elements of GPCM1 and is geared toward patients with two or more chronic conditions, which are expected to continue for at least 12 months and place the patient at significant risk of death, acute exacerbation, or functional decline. G0557 is $50 per patient per month with an RVU value of 0.77.
G0558 is appropriate for any patient who is a Qualified Medicare Beneficiary (QMB) and meets the criteria for G0557. G0558 is $110 per patient per month with an RVU value of 1.67.

Learn how HealthViewX Advanced Primary Care Management application can elevate your practice by scheduling a no-obligation demo.

Schedule A Demo