APCM guide: codes, requirements and 2026 rates.

What is advanced primary care management?

CMS created APCM in the CY 2025 Physician Fee Schedule final rule, effective January 1, 2025. It pays a practice a monthly amount for running advanced primary care: being the continuing focal point for all of a patient's needed services, with care management, 24/7 access, and population-level quality work built in. The services are provided by clinical staff and directed by a physician or other qualified professional who is responsible for all of the patient's primary care.

APCM is not time based. There are no minutes to log, and CMS says you do not have to provide every service element every month. You bill once per patient per calendar month, and only one practitioner can be paid for APCM for a patient in a given month.

APCM codes and 2026 rates

The level depends on how many chronic conditions the patient has and whether they are a Qualified Medicare Beneficiary.

Medicare pays 80% of the allowed amount and the patient owes 20% coinsurance after the Part B deductible. CMS has said it has no statutory authority to waive that coinsurance. For Level 3 patients, who are dual eligible, Medicaid is responsible for the cost sharing.

Service elements CMS expects

The code descriptors list these elements, each provided as appropriate for the patient:

• Consent, with the patient told that cost sharing may apply and that they can stop at the end of any month.
• An initiating visit for new patients, unless the patient was seen by someone in the practice within the past three years.
• 24/7 access to the care team or practitioner for urgent needs, and continuity with a designated care team member.
• Care delivered in alternative ways when it helps, such as home visits or expanded hours.
• Comprehensive care management: needs assessment, preventive services, and medication reconciliation.
• An electronic, patient-centered comprehensive care plan.
• Coordination of care transitions, including follow-up within 7 calendar days of a discharge when clinically indicated.
• Coordination with community and social service providers.
• Enhanced communication such as secure messaging, a patient portal, e-visits, and virtual check-ins.
• Population management: analyzing patient data to find gaps in care and risk stratifying the practice population.
• Performance measurement of primary care quality, total cost of care, and meaningful use of certified EHR technology.

The performance measurement element can be met by reporting the Value in Primary Care MIPS Value Pathway, or through participation in a Medicare Shared Savings Program ACO.

New in 2026: behavioral health add-on codes

The CY 2026 final rule added three add-on codes that the same practitioner can bill in the same month as an APCM base code, so practices can integrate behavioral health without counting minutes.

The time requirements of 99492, 99493 and 99484 still apply when those codes are billed on their own. With APCM, CMS dropped the minute counting but expects the behavioral health care to be documented in the record. Rural health clinics and FQHCs can report the add-ons too, paid at the national non-facility rate.

For integrated primary care and behavioral health practices, this is the largest change of the year: a Level 2 patient in collaborative care can now carry an APCM base code and a collaborative care add-on in the same month.

APCM vs CCM: which to bill

The same practitioner cannot bill APCM in the same month as CCM, principal care management, transitional care management, interprofessional consultations, virtual check-ins or e-visits for that patient. A different practitioner can, when it is medically necessary. Behavioral health integration, community health integration, principal illness navigation, SDOH risk assessment, and remote monitoring can all be billed alongside APCM, as long as no time or effort is counted twice.

In practice, APCM rewards a practice that touches many patients lightly every month, while CCM rewards deeper, documented time with fewer patients. Read our chronic care management overview for the CCM side.

Running APCM without adding headcount

Because APCM is not time based, its value comes from doing the elements consistently for every enrolled patient: following up within a week of a discharge, closing care gaps, answering messages, and keeping the care plan current. That is high-volume, repetitive work, and it is where Vybz AI care teams help.

Where an AI care team fits

• Between-visit check-ins by text, with replies summarized for your care team and concerns escalated the same day.
• Answering patient messages around the clock and routing urgent needs to your on-call clinician.
• Reaching out after discharges your team flags, so a clinician can follow up inside the 7-day window.
• Building each month's worklist of open care gaps from the data already in your EHR.