Advanced Primary Care Management (APCM) in 2026: What Providers Need to Know
- Ioannis M. Kalouris, MD
- 2 days ago
- 3 min read
Primary Care is moving more towards a relationship-based care model where continuity and proactive outreach are not at the center of a care-shifting model. Updated models through 2026 fall under the Medicare Physician Fee Schedule (PFS), and APCM integrates several care Management functions into a single, streamlined, monthly payment offering practices more flexibility, better alignment with value-based care, and increased financial stability. Medicare is extending more value-based care revenue opportunities in primary care.
From your chronic care coordination, outreach, and or behavioral healthcare supportive programs, most practices will want to understand what will be offered in 2026 in APCM.
What APCM Is and Why It Is Important in 2026
APCM replaces arbitrary, time-focused, and single-event fee billing with a model based on three monthly HCPCS G codes G0556, G0557, and G0558, based not on minutes of documentation and team effort, but solely on the risk level of the patient. This will substantially reduce box checking and improve patient care.
Approximate National Payment Levels for 2026
G0556 – ~$16 pmpm (lower-complexity patients)
G0557 – ~$54 pmpm (moderate/complex patients)
G0558 – ~$117 pmpm (high-need, vulnerable patients)
Reimbursement is clearly moving in the right direction in line with outcome improvement, but actual reimbursement will vary geographically: APCM is a rapidly ascending portion of the revenue stack of primary care.
What is Coming for APCM in 2026
Behavioral Health Add-On Codes
Beginning in 2026, practices can report behavioral health integration (BHI) or Collaborative Care Model (CoCM) add-on codes in conjunction with APCM. This change enables whole person care—physical, behavioral, and social—to function in one model. For many clinics, this is the key to developing viable integrated care.
Alignment With MIPS & Value-Based Care
CMS now associates APCM with the Value in Primary Care MIPS Value Pathway (MVP) and ACO models. APCM practices will begin reporting on their performance in 2026 for the 2025 performance year. This creates a consistent and predictable pathway for providers to follow as they advance toward population-based contracts.
Reduced Administrative Burden
2026 APCM removes the time tracking requirements that make CCM and other care management programs burdensome. Practices are encouraged to concentrate on care plans, communication, and other meaningful interventions rather than micromanaging to reach minute thresholds.
How APCM Differs From CCM and Standard Primary Care
APCM vs. CCM
CCM requires logging time and managing strict documentation rules.
APCM is risk-based, not time-based, giving practices more clinical flexibility.
APCM vs. Traditional Fee-for-Service
Fee-for-service rewards visits.
APCM rewards ongoing relationships—virtual touchpoints, coordination, education, medication management, and real-world follow-up.
APCM may not be billed in the same month as CCM/PCM/TCM by the same practice; however, it can be combined with:
✔ Remote Patient Monitoring (RPM)
✔ Remote Therapeutic Monitoring (RTM)
✔ 2026 Behavioral Health Add-Ons
✔ Annual Wellness Visits (AWV)
These programs combine to create a strong foundation for revenue and outcomes.
Eligibility & Requirements for 2026
To bill APCM, a patient must:
Have an established relationship with your practice
Match the appropriate risk-stratification level
Provide consent
Receive continued advanced primary care services
Practices must ensure:
24/7 access to a care team with EHR access
Team-based care (RNs, LPNs, MAs, care coordinators)
Active, electronic care plans
Coordinated transitions of care
Documentation of outreach, review, management, education, and follow-up
APCM is ABOUT funds reflecting activities that are already performed—APCM just funds those activities more efficiently and intelligently.
How Enable Healthcare Helps Practices Scale APCM
Enable is allowing practices to scale, working with Enable to get the right technology, the right workflows, the right analytics, the right staffing, and everything needed to implement APCM at any risk level.
Integrated with EHI’s EHR, care-management, and AI-powered ecosystems (Lumina AI Scribe, RevQ AI Modeling, Echo AI Front Office, Care Coordination Charts), practices can:
Identify and risk-stratify eligible patients using diagnosis codes, utilization trends, and social determinants
Automate APCM enrollment workflows and patient consent
Generate AI-assisted documentation that captures care management activities clearly and with compliance
Leverage multilingual clinical staff (LPNs, RNs, care coordinators) to perform outreach and close care gaps
Use FTC-compliant calling technology to avoid “spam likely” flags
Integrate APCM with CCM, RPM, AWV, and BHI without double-billing
Track quality metrics tied to MIPS and ACO pathways
Ensure accurate billing and clean claims through RevQ’s AI-modeled revenue-cycle engine
The bottom line is that with EHI, APCM is streamlined, extensible, and profitable.
Sources
(2025). CMS Issues Final 2025 Calendar Year Medicare Physician Fee Schedule Final Rule. Centers for Medicare & Medicaid Services, 2025 Medicare Physician Fee Schedule Final Rule. https://www.jdsupra.com/legalnews/cms-issues-final-2025-calendar-year-1196924/
(2025).
PROPOSED CY 2026 MEDICARE PHYSICIAN FEE SCHEDULE FACT SHEET. Center for Connected Health Policy / Public Health Institute.https://www.cchpca.org/2025/07/PROPOSED-2026-PHYSICIAN-FEE-SCHEDULE-FINAL.pdf (2024).
Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-proposed-rule (2025)
Medicare Physician Fee Schedule (PFS) 2026 Overview: Key Updates and 2025 vs 2026 Comparison. Medicare Physician Fee Schedule (PFS) 2026 Overview: Key Updates and 2025 vs 2026 Comparison. https://oncare360.com/learning-center/medicare-physician-fee-schedule-2026-updates-comparison
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