CMS Finalizes New Advanced Primary Care Management Services for 2025

CMS Finalizes New Advanced Primary Care Management Services for 2025

Today, the Centers for Medicare & Medicaid Services (CMS) finalized its Advanced Primary Care Management (APCM) services proposal for 2025, marking a significant shift in how Medicare will pay for primary care services. The final rule maintains the core structure proposed earlier this year while providing some important clarifications and updates.

The finalized APCM services will be implemented through three new HCPCS G-codes (G0556, G0557, G0558), replacing the placeholder GPCM codes from the proposed rule. These codes maintain the three-tier structure based on patient complexity: 

• Level 1 (G0556) for patients with one chronic condition
• Level 2 (G0557) for those with two or more chronic conditions
• Level 3 (G0558) for patients with multiple chronic conditions who also qualify as Medicare beneficiaries.

A key difference from traditional care management codes is that APCM services will not require time-based documentation, significantly reducing administrative burden for practices. The final rule confirms that practices participating in Medicare Shared Savings Program ACOs, REACH ACOs, Primary Care First, or Making Care Primary programs will automatically satisfy many APCM requirements through their existing program participation. This alignment demonstrates CMS’s commitment to streamlining value-based care initiatives and reducing duplicate reporting requirements.

For more information about APCM, visit our APCM Resource Center and sign up for our Webinar on November 14, 2024 at 10am PT – “Understanding APCM: Requirements, Technology & Implementation.”

Major Medicare Changes Coming for Rural Health Clinics and FQHCs: A Win for Community Healthcare

Also in today’s final rule is a significant move to support rural and underserved communities: CMS announced positive changes to how Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) will bill for care coordination services starting in 2025. This change marks a pivotal shift from the current one-size-fits-all approach to a more nuanced and fair payment system that better reflects the complex care these essential facilities provide.

Under the new structure, health centers will transition from using the general G0511 code to specific service-based codes, allowing for more accurate payment and the ability to bill for add-on services. This change acknowledges the extensive care coordination work these facilities perform and provides additional compensation beyond their standard payment rates. 

CMS has established a transition period through July 2025, ensuring facilities have adequate time to implement necessary system updates. This reform represents a significant step forward in supporting the sustainability of essential safety-net providers while improving transparency in healthcare delivery for Medicare beneficiaries.