2025 Advanced Primary Care Management Billing Guide

What to know about coding, billing, and getting paid for APCM

Advanced Primary Care Management (APCM) is CMS’s new and innovative program and payment model. APCM builds on the foundation of previous preventive care initiatives, borrowing key elements from chronic care management (CCM) while removing time-based requirements. APCM provides physician practices and federally qualified health centers (FQHCs) with a streamlined and impactful way to deliver high-quality services while also unlocking an additional recurring revenue stream. 

Download the APCM billing guide to learn more about:

• APCM HCPCS codes and reimbursement
• Return on investment of an APCM program
• 13 service elements practices must be prepared to deliver, as required by CMS
• Complementary programs to maximize revenue and improve patient outcomes

Disclaimer:

Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.  
  
Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.  
  
Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.  
  
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.  
  
The coding options listed here are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.  
  
The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.