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What is APCM?

Advanced Primary Care Management (APCM) is a Medicare initiated program that provides a comprehensive and coordinated approach to primary care, emphasizes proactive, patient-centered, and data-driven management of patients' health. APCM allows care providers to deliver continuous, proactive care to patients by bridging the traditional fee for services care with value-based care and population focused care.  APCM offers customized care plans for a wide range of patients' needs from low to high complexity. A strong foundational primary care system is fundamental to improving health outcomes, lower mortality, and reducing health disparities, which is why CMS has been taking action to strengthen the primary care including new coding, and payment for APCM in 2025 PFS final rule. 

Goals of APCM

  • Improve patient outcomes, reduce complications, and promote healthy behaviors.

  • Foster patient-centered care, improve satisfaction, and support patient engagement.

  • Optimize resource utilization, reduce unnecessary hospitalizations, and minimize waste. 

  • Contribute to improved population health outcomes, reduced health disparities, and enhanced     community well-being. 

Key Components of APCM

The focus of APCM is on activities and outcomes rather than time.  APCM does require quality measurement reporting, by which success of the program can be determined.  In addition, only primary care providers are eligible for APCM.  

  • Due to overlap in care, CCM and APCM programs cannot be run and charged by a provider or another provider in the same practice simultaneously for a patient.  Other codes that overlap include those for TCM, PCM, and 15 communication-based technology CPT codes. 

  • Practices may enroll patients in different overlapping programs, but not at the same time. 

  • Patients are allowed to be enrolled in support programs such as RPM , Remote Therapeutic Monitoring (RTM), Health Related Social Needs (HRSM), and Behavioral Health Integrations (BHI) which are viewed as complementary. 

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