Medicare pays $16, $54, or $117 per patient per month for Advanced Primary Care Management (APCM) in 2026, by patient level. These are the national non-facility amounts in the relative value file that CMS released on August 26, 2026, rounded to the nearest dollar.
APCM is a monthly bundle for primary care and needs no time log. A panel of 100 level 1 patients brings in $1,637 a month, and the same panel at level 3 brings in $11,724.
What each APCM level pays
APCM has three levels, set by the number of chronic conditions. According to the CMS APCM FAQ, level 1 (G0556) covers patients with zero to one chronic condition. Level 2 (G0557) covers patients with two or more. Level 3 (G0558) covers patients with two or more chronic conditions who are in the Qualified Medicare Beneficiary (QMB) program.
The American Academy of Family Physicians lists the 2025 amounts as $15, $49, and $107 a month. The October release of the CMS 2026 relative value file prices the same codes at 0.49, 1.61, and 3.51 total non-facility relative value units. Each value times the 2026 conversion factor for non-qualifying participants gives the 2026 amounts.
| Level | Patients covered | Code | 2025 amount (AAFP) | 2026 non-facility (CMS) | 2026 facility (CMS) | Change, 2025 to 2026 |
|---|---|---|---|---|---|---|
| 1 | 0 to 1 chronic conditions | G0556 | $15 | $16 | $11 | 7.7% |
| 2 | 2 or more chronic conditions | G0557 | $49 | $54 | $34 | 10.1% |
| 3 | 2 or more, plus QMB status | G0558 | $107 | $117 | $73 | 9.5% |
Sources: AAFP for 2025 amounts. CMS, 2026 National Physician Fee Schedule Relative Value File, October release, for 2026 amounts (total relative value units times the non-qualifying conversion factor). Dollars are rounded. Percent change uses unrounded amounts.
Level 2 gained the most, at 10.1%. The facility amount is 32.7% below the non-facility amount at level 1, 37.3% below at level 2, and 37.9% below at level 3. The CMS FAQ says APCM is priced in both settings and that FQHCs and RHCs are paid the non-facility amount.
How APCM compares with other care management codes
APCM pays a flat monthly amount. The older codes pay by the minute of documented time. In the 2026 CMS file, the national non-facility amounts for the codes below run from $50 to $299.
| Code | Service | 2026 national non-facility amount | Unit |
|---|---|---|---|
| G0557 | APCM, level 2 | $54 | Per month, no time log |
| 99490 | Chronic care management, clinical staff | $66 | First 20 minutes |
| 99439 | Chronic care management, clinical staff | $50 | Each added 20 minutes |
| 99491 | Chronic care management, physician | $89 | First 30 minutes |
| 99487 | Complex chronic care management | $144 | First 60 minutes |
| 99424 | Principal care management, physician | $88 | First 30 minutes |
| 99457 | Remote monitoring treatment management | $52 | First 20 minutes |
| 99495 | Transitional care, moderate complexity | $220 | Visit within 14 days |
| 99496 | Transitional care, high complexity | $299 | Visit within 7 days |
| 99214 | Office visit, established patient, moderate | $136 | Per visit |
Source: CMS, 2026 National Physician Fee Schedule Relative Value File, October release. Dollars are rounded.
A level 2 APCM month equals 81.3% of the first 20-minute chronic care management payment. Forty minutes of clinical staff time (99490 plus one unit of 99439) pays $117, within a dollar of a level 3 APCM month. One 99214 office visit pays 2.5 times a level 2 APCM month.
What a panel earns per month and per year
A panel of 100 patients billed at level 2 for 12 months brings in $64,531. The same panel at level 1 brings in $19,640, and at level 3 it brings in $140,685. A practice with 1,000 level 2 patients bills $53,775 a month.
| Level | Per month, 100 patients | Per year, 100 patients |
|---|---|---|
| 1 | $1,637 | $19,640 |
| 2 | $5,378 | $64,531 |
| 3 | $11,724 | $140,685 |
Source: calculated from the 2026 CMS relative value file, non-facility amounts. Annual figures use unrounded monthly amounts.
The same 100 level 2 patients paid $4,884 a month in 2025. The 2026 amount adds $494 a month, or $5,923 a year. At the facility amount, 100 level 2 patients bring in $3,373 a month. Real revenue depends on the mix of levels, and each patient needs consent and an initiating visit before the practice bills.
In the 2027 proposed rule, CMS proposes to cut the conversion factor by 1.7% for non-qualifying participants and by 1.2% for qualifying participants. On the 2026 relative value units, that moves level 2 from $54 to $53 a month and level 3 from $117 to $115. Level 1 stays at $16. The rule is not final, and the estimate holds the 2026 units constant.
How many patients get care management today
Avalere Health analyzed Medicare fee-for-service claims for 2019 through 2023. It found that nearly 1.3 million beneficiaries received chronic care management (CCM) in 2023, which is 23.4% more than in 2022. Average annual growth from 2019 to 2023 was 7.4%. CCM claims totaled 6.5 million in 2023, or 5.1 per beneficiary, up from 4.9 in 2019.
Two-thirds of Medicare beneficiaries have two or more chronic conditions, according to Avalere. A 2023 Innovation in Aging study used a 5% sample of fee-for-service beneficiaries aged 65 and older. It found that 1.1% of eligible beneficiaries received CCM in 2015 and 3.4% in 2019. About 1.4 million beneficiaries a year were in the sample, and roughly 75% had two or more chronic conditions. Use rose from 2.0% to 7.0% among beneficiaries with 10 or more chronic diseases, and from 0.7% to 2.1% among those with two to five. Among severely frail beneficiaries, use reached 9.4% by 2019. In 2019, 6.1% of eligible beneficiaries in Georgia received CCM, against 0.1% in Vermont.
The CMS 2026 final rule states that 6 in 10 Americans have at least one chronic disease and 4 in 10 have two or more.
Billing rules to check before you enroll patients
The CMS FAQ requires an initiating visit for all new patients and for patients the billing practitioner has not seen in 3 years. These visits count if the practitioner discusses APCM at the visit:
- An office visit at level 2 through 5 (99212 to 99215)
- A transitional care visit (99495 or 99496)
- An annual wellness visit
- An initial preventive exam
The Rural Health Information Hub, on a page dated February 20, 2026, says the practice needs written or verbal consent once per patient. Only one practitioner can provide APCM in a month. Cost sharing applies to the patient, according to AAFP.
By billing APCM, the practitioner attests that the requirements in the code descriptor are met. The CMS FAQ does not expect the practice to record those practice-level requirements in each patient's chart.
The level depends on the diagnoses on record. Avalere's review of 2023 CCM claims shows why: 77% listed two or more chronic conditions, 18% listed one, and 5% listed none.
The CMS 2026 final rule added three add-on codes for behavioral health integration. A practitioner can bill them in the same month as an APCM base code. The 2026 file pays $162 for G0568, $146 for G0569, and $58 for G0570.
Sources
- CMS, 2026 National Physician Fee Schedule Relative Value File, October release (RVU26D), August 26, 2026
- AAFP, Using Advanced Primary Care Management Services Codes G0556, G0557 and G0558, accessed September 26, 2026
- CMS, Advanced Primary Care Management (APCM) Services FAQ, accessed September 26, 2026
- Rural Health Information Hub, Advanced Primary Care Management, February 20, 2026
- CMS, Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F), October 31, 2025
- CMS, Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, July 2026
- Avalere Health, Chronic care management in Medicare: Optimizing utilization, June 18, 2025
- Innovation in Aging, Use of chronic care management service among Medicare beneficiaries in 2015-2019, 2023
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