Assess capabilities
We map what the APCM service elements require against how your practice works today.
Chronic & complex careAPCM
APCM bundles care management and communication services into a single monthly code billed by the patient's primary-care practice, without minute thresholds. We help practices stand up the capabilities the codes expect — consent, care plans, access, coordination and tracking — and keep them running every month.
Who qualifies
Eligibility is confirmed against your own population before a pilot group is approached.
- 01
The practice is responsible for the patient's ongoing primary care
- 02
Consent documented, including cost-sharing information
- 03
Practice capabilities in place: 24/7 access, continuity, care plans and coordination
- 04
Patients assigned to a tier by number of chronic conditions and QMB status
What your patients experience
- Easier access to their primary-care team
- Coordinated referrals and follow-up
- A care plan when they need one
- Consistent contact without per-call counting
How we run it
Your clinicians keep every clinical decision. We run the operations around them.
Assign tiers
Patients are grouped into the correct level using your problem lists and coverage data.
Enroll and inform
Consent and cost-sharing information are captured through approved scripts.
Run the month
Outreach, care coordination and transitions are tracked as ongoing work queues.
Evidence and review
Monthly records show the services delivered so billing decisions are documented.
Stays with your clinicians
Primary-care decisions, care-plan approval and behavioral-health treatment remain with the practice's clinicians.
What your practice receives
- Capability gap assessment
- Tier assignment by patient
- Monthly activity evidence
- Operating playbook for the whole care team
Billing reference
Listed as published for calendar year 2026 under the Medicare Physician Fee Schedule. Requirements, documentation rules and payer policies change — confirm current CMS and payer guidance with your billing team. Carevory does not guarantee reimbursement. APCM billing codes
| Code | What it covers |
|---|---|
| G0556 | Patients with one or no chronic conditions, per calendar month |
| G0557 | Patients with two or more chronic conditions |
| G0558 | Patients with two or more chronic conditions who are Qualified Medicare Beneficiaries |
| G0568–G0570 | Optional behavioral-health integration add-ons, new for 2026 |
Carevory does not guarantee reimbursement. Confirm current CMS and payer guidance with your billing team before you bill.
Often combined with
The same minutes are never counted toward two programs — time is logged against one at a time.
FAQ
What practices ask before launching APCM.
For a given patient and month a practice generally chooses one or the other. We model both against your population before you decide.
No. APCM is billed monthly when the required service elements are available and provided, rather than on time thresholds.
Your clinicians, or qualified clinical staff working under your supervision and protocols where contracted. Carevory runs the operations around them: eligibility, enrollment, outreach, scheduling, queues, documentation and reporting.
No. Payer rules, documentation and clinical decisions determine payment. We help you meet program requirements and give you clean records for billing review.
Start with one workflow
Tell us about your patient population, systems and staffing. We'll scope a pilot group, the workflow and the reporting you'd see each month.
Business inquiries only. Please don't include patient information.