Advanced Primary Care Management · APCMMore continuity. An extended primary care team.

• The patient has an ongoing primary-care relationship with the practitioner who serves as the focal point for needed care.
• The patient would benefit from coordinated primary care, transition support, communication, and a living care plan.
• The practice can deliver all APCM service elements appropriate to the patient and has obtained consent.

• Named primary-care practitioner responsible for all primary-care services
• Capability map covering 24/7 clinical access, continuity, care planning, transitions, communication, and population management
• Patient consent and electronic care-plan workflow
• Clear assignment of MySeema work versus practice-owned clinical and operational capabilities
• Performance measurement and current billing review

Conditional on the practice delivering every required APCM capability

• Exactly one appropriate tier per patient per calendar month; no minute threshold.
• G0556 is level 1; G0557 requires two or more qualifying chronic conditions; G0558 also requires verified QMB status.
• Required capabilities include access, continuity, care planning, transitions, coordination, enhanced communication, population management and performance measurement.
• Apply initiating-visit rules and established-patient exceptions before enrollment.
• The same practitioner must not separately bill bundled CCM/PCM/TCM or included communication services for that patient/month.

Patient cost sharing and protections depend on coverage and the service. Explain them before consent. Do not use this illustration to charge a Qualified Medicare Beneficiary protected amounts. RHC/FQHC payment rules and Medicare Advantage contracts differ from the national PFS benchmark.