CCM vs APCM comes down to time tracking. Chronic Care Management (CCM) pays per documented block of staff or practitioner minutes each month. Advanced Primary Care Management (APCM) pays a flat monthly amount by complexity level, with no minutes to count. The same practitioner can't bill both for one patient in the same month, so pick per patient.
Takeaways
CCM pays for time
99490 is about $66 in 2026 for the first 20 minutes of clinical staff time. No documented minutes, no claim.
APCM pays for the month
G0556, G0557 and G0558 run about $16, $54 and $117. CMS removed time thresholds entirely.
One practitioner, one code family per month
APCM can't be billed with CCM, PCM or TCM by the same practitioner for the same patient in the same month.
Consent is the bottleneck for both
Each needs documented consent before you bill. That conversation is an outreach job.
What CCM and APCM actually are
CCM is a monthly Medicare service for patients with 2 or more chronic conditions. CMS requires conditions "expected to last at least 12 months, or until the patient's death." Those conditions must put the patient at significant risk of death, acute decompensation, or functional decline. You bill it in time blocks. See our CCM glossary entry for the basics.
APCM started January 1, 2025. It bundles care management into one monthly code. You pick the level by the patient's profile, not by minutes. Our APCM glossary entry covers the background.
The APCM levels are simple:
- G0556 (Level 1): 0 or 1 chronic condition.
- G0557 (Level 2): 2 or more chronic conditions.
- G0558 (Level 3): 2 or more chronic conditions and Qualified Medicare Beneficiary (QMB) status. QMB is a Medicaid program that covers Medicare cost-sharing for low-income patients.
2026 payment amounts
These are 2026 national non-facility amounts. Your locality will differ, so check the CMS PFS Look-Up Tool before you budget. The amount is the full allowed charge, split between Medicare and the patient's coinsurance.
CCM codes:
- 99490: about $66. First 20 minutes of clinical staff time.
- 99439: about $50. Each additional 20 minutes of staff time.
- 99491: about $89. First 30 minutes of practitioner time.
- 99487: about $144. Complex CCM, first 60 minutes of staff time.
APCM codes:
- G0556: about $16.
- G0557: about $54.
- G0558: about $117.
Care management codes are exempt from the 2026 efficiency adjustment, the -2.5% cut CMS applied to work RVUs for many other services.
Requirements side by side
| Feature | CCM (99490, 99439, 99491, 99487) | APCM (G0556, G0557, G0558) |
|---|---|---|
| Who qualifies | 2+ chronic conditions expected to last 12+ months with significant risk | No chronic condition minimum; level set by condition count and QMB status |
| Time requirement | 20, 30 or 60 minutes per month depending on code | None. Billed per calendar month |
| Consent | Verbal or written, documented | Verbal or written, documented once before billing starts |
| Care plan | Electronic, patient-centered comprehensive care plan | Electronic care plan as one of the service elements |
| Access | 24/7 access to a practitioner or clinical staff for urgent needs | 24/7 access and continuity of care |
| New patients | Initiating visit if not seen in the past year | Initiating visit for new patients |
| Billing with TCM | Allowed during the 30-day TCM period | Not by the same practitioner in the same month |
Two details matter most.
No time requirement for APCM. AAFP puts it plainly: "Time thresholds eliminated for APCM services." You still have to be able to deliver the service elements. These include 24/7 access, care transitions, coordination with other providers, and population-level management. AAFP notes that not every element is needed for every patient every month.
The same-practitioner restriction. One practitioner can't bill APCM alongside CCM, PCM or TCM for the same patient in the same month. PCM is principal care management, for one serious condition. TCM is transitional care management, after a discharge. Other clinicians in the group can still bill those services. If a patient qualifies for both in a month, AAFP says "the practice may choose which service they would like to report for the month."
Consent rules
Both programs need documented consent before the first claim. For CCM, CMS says the patient must be told:
- The service is available.
- Cost-sharing applies.
- Only one practitioner can bill CCM per month.
- They can stop at any time.
APCM consent follows the same pattern. It is required once, before billing starts, and can be verbal or written. The patient hears that cost-sharing applies, that only one clinician can bill APCM per month, and that they can stop anytime.
New in 2026: behavioral health add-ons
The 2026 fee schedule finalized 3 add-on codes for behavioral health integration under APCM. They can be billed only when "the APCM base code is reported by the same practitioner in the same month."
- G0568: psychiatric Collaborative Care Model (CoCM), initial month.
- G0569: CoCM, subsequent months.
- G0570: general behavioral health integration (BHI).
Check your MAC's guidance for full descriptors and local rates before billing these.
How to choose, and what the money looks like
Use this rule of thumb:
- Lean CCM for patients who need a lot of documented staff time every month. Complex CCM at about $144 rewards that work.
- Lean APCM when your team can't reliably log minutes, or when you want to cover patients with 0 or 1 chronic condition. CCM can't bill for those at all.
The revenue math is the same for both:
Hypothetical example, for illustration only. A practice enrolls 200 patients in APCM Level 2. At about $54 each, that's about $10,800 a month in allowed charges. The same 200 patients in CCM at about $66 bring in about $13,200, but only in months when each patient hits 20 documented staff minutes. Your real numbers depend on enrollment, locality, and how many CCM months you can actually document.
The variable you control is the first one: enrolled patients. Most programs stall there, not on rates.
Where outreach fits
Two parts of either program are outreach work.
Consent conversations. Someone has to call each eligible patient, explain the program, and answer cost-sharing questions. Rivvi can find eligible patients in the lists you upload. On the Team plan, it calls or texts them, explains the program, and warm-transfers interested patients to your staff to complete and document consent. If no one is free, it creates a follow-up task instead. Outcomes are logged in Rivvi and pushed to HubSpot, Salesforce or Zoho if you've connected one.
Monthly check-ins. Routine check-ins keep patients engaged between visits. Be clear on one point: AI call time is not clinical staff time. It doesn't count toward CCM minutes. The AI handles the reach and the routing. Your clinical staff do and document the billable work.
Start with the eligibility list. Upload your patient roster to the HIPAA-compliant AI workspace. Ask which patients have 2 or more chronic conditions and no care management claim this year. The free plan covers you and two colleagues with a BAA. For more on post-discharge billing, read our TCM billing guide.
Find your eligible patients today
Upload your roster, sort CCM and APCM candidates, and start consent outreach. Free for you and two colleagues, with a HIPAA BAA.
Sources
- CMS MLN909188: Chronic Care Management Services (June 2025)
- CMS: Advanced Primary Care Management Services FAQ
- AAFP: Advanced Primary Care Management
- NACHC: APCM Reimbursement Tip Sheet
- AMA: CY2025 Medicare Physician Fee Schedule Summary
- CMS: CY2026 Physician Fee Schedule Final Rule Fact Sheet
- Cotiviti: New Behavioral Health Codes for APCM Services
- MedFeeSchedule: 2026 national payment amounts by code (99490, 99439, 99491, 99487, G0556, G0557, G0558)
- CMS Physician Fee Schedule Look-Up Tool