What is Advanced Primary Care Management (APCM)?

In 2024, CMS introduced new reimbursement opportunities for primary care practices through the 2025 Medicare Physician Fee Schedule Proposed Rule. Advanced Primary Care Management (APCM) is a new initiative meant to support primary care physicians to move towards value-based care. The goals of the program are to improve provider/patient relationships while supporting reimbursement for risk-stratified care management services.

How is APCM different from existing Medicare care management programs?

The proposed Advanced Primary Care Management program is different in four ways:

  • APCM offers three new billing codes corresponding to three risk levels. Patients are to be stratified and invited to enroll in the most appropriate level for their health needs.
  • APCM focuses on activities and not time. The monthly per patient per month rates cover all care management activities and do not have a required minimum to be billed.
  • APCM is available to all Medicare beneficiaries who may benefit because the first risk level includes patients with one or no chronic conditions.
  • APCM requires quality measurement and reporting, focusing on value-based care.
These enhancements reflect a shift toward value-based care, empowering providers to better manage their patient populations and reduce long-term healthcare costs.

key cms changes

How does APCM affect my CCM and PCM existing patients?

If CMS accepts the 2025 Medicare Physician Fee Schedule Proposed Rule, APCM would be available January 1, 2025. Practices that already participate in CCM and PCM can also participate in APCM. However, a patient can only be enrolled in and billed under one monthly program (either CCM or APCM-not both). Patients enrolled in CCM or PCM would need to be re-enrolled in APCM.

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