The following are approximate national average reimbursement rates for APCM services effective January 1, 2026.
HCPCS Code | Level | Patient Population | 2026 National Average:
| G0556 | Level 1 | 0-1 chronic conditions | ~$16 |
| G0557 | Level 2 | 2+ chronic conditions | ~$54 |
| G0558 | Level 3 | 2+ chronic conditions + QMB status | ~$117 |
Only one APCM code may be billed per patient per calendar month. The patient's tier is determined by their number of chronic conditions and QMB status.
APCM reimbursement increased from 2025 to 2026, reflecting the updated conversion factor. The 2025 national averages were approximately $15.20 (G0556), $48.84 (G0557), and $107.07 (G0558).
Revenue Comparison: APCM vs. CCM:
For a practice billing CCM with consistent 40-minute monthly engagements (99490 + 99439), the combined CCM revenue is approximately $116 per patient per month. Under APCM G0557, the same patient generates approximately $54. However, APCM does not require minute-by-minute time documentation, making it operationally simpler. Practices must evaluate their patient panel composition, documentation capabilities, and staff capacity to determine which program generates the best clinical and financial outcome.
For practices with significant QMB populations, APCM G0558 ($117) is competitive with or exceeds CCM base code revenue.
Sources:
CMS CY 2025 and CY 2026 PFS Final Rules;
AAFP APCM coding guidance;
RHIhub APCM overview.
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