Three Risk Levels, Three New Codes 🔢

APCM bundles elements from Chronic Care Management, Principal Care Management, Transitional Care, and tech-based services into three monthly codes—no stopwatch required:

• GPCM1 (G0556): Low risk (0–1 chronic conditions)
  – $15.20/mo | 0.25 RVUs
  – Ongoing support for preventive care and general wellness
  
  
• GPCM2 (G0557): Medium risk (≥2 chronic conditions)
  – $48.84/mo | 0.77 RVUs
  – For patients at risk of acute events or functional decline
  
  
• GPCM3 (G0558): High-need dual eligibles (QMBs)
  – $107.07/mo | 1.67 RVUs
  – Same clinical intensity as GPCM2, but no patient cost-sharing
  
  

QMBs are Medicare beneficiaries whose states cover their deductibles, copays, and coinsurance.

How APCM Stands Out ✨

1. Risk-Stratified, Not Time-Based
   Bill by complexity, not minutes. Focus on impact, not stopwatch reading.
   
   
2. Universal Eligibility
   Every Medicare patient counts—even those with zero chronic conditions.
   
   
3. Activity & Outcome Focus
   No minimum time logs—just meaningful touchpoints, care coordination, and results.
   
   
4. Quality & Reporting Required
   APCM lives in the MIPS/Value in Primary Care world. You’ll report outcomes and cost metrics starting with the 2025 performance year.
   
   

Core Service Elements 🛠️

APCM asks you to weave together up to 13 care components, choosing what fits each patient:

• Consent & Initiation: Re-enroll and kick off with a visit (if none in past 3 years).
  
  
• 24/7 Access & Continuity: Designated team member for ongoing support.
  
  
• Patient-Centered Options: Home visits, extended hours, virtual check-ins.
  
  
• Comprehensive Care Planning: Electronic, shareable, and proactive.
  
  
• Care Transitions & Community Links: Smooth handoffs within 7 days of discharge plus social-services coordination.
  
  
• Digital & Asynchronous Communication: Secure messaging, portals, apps—beyond phone calls.
  
  

Data-Driven Management: Stratify risk, close care gaps, and report on performance.