CCM vs. APCM: Which Care Management Model Is Right for Your Practice?
- June 26, 2026
- | 4.5 minute read
For years, primary care has been shifting away from a system that only pays when a patient walks through the door. More and more, Medicare rewards the work that happens between visits, including the phone check-ins, medication reviews, and care coordination that keep patients healthy and out of the hospital.
Two Medicare programs pay for that work: Chronic Care Management (CCM) and the newer Advanced Primary Care Management (APCM), which the Centers for Medicare & Medicaid Services launched on January 1, 2025. If you already bill CCM or are weighing whether to start, here is a look at how the two compare and how to decide which is the right fit.
What is Advanced Primary Care Management (APCM)?
APCM takes a different approach. Instead of counting minutes, it pays a flat monthly amount based on the care services you make available to a patient. No stopwatch required.
It is also far broader. This Medicare Advanced Primary Care Management program is open to every Medicare patient, not just those with multiple chronic conditions. Payments are risk-stratified into three levels based on patient complexity using HCPCS codes G0556 (Level 1), G0557 (Level 2), and G0558 (Level 3). Healthier patients and high-complexity patients are paid differently, so your reimbursement reflects the actual work involved.
According to the National Association of Community Health Centers (NACHC), the national average reimbursement is roughly $16.37 for Level 1 (G0556), $53.78 for Level 2 (G0557), and $117.24 for Level 3 (G0558).
APCM also includes a quality reporting component that aligns with CMS’s broader push toward value-based care, supported by nationwide interoperability.
APCM is not requirement-free, though. To bill it, practices need to meet a set of service standards, such as 24/7 access for urgent needs, an initiating visit, and separate patient consent. A CCM consent does not carry over to APCM.
The Differences, Side by Side
| Feature | CCM (Chronic Care Management) | APCM (Advanced Primary Care Management) |
| Who qualifies | Patients with 2+ chronic conditions expected to last 12+ months | Every Medicare beneficiary, including patients with one or no chronic condition |
| Billing basis | Time-based (you bill only when minutes are met) | Service availability (no time clock to hit) |
| Monthly time minimum | 20+ minutes of clinical staff time, every calendar month | None (no per-minute requirement) |
| Documentation | Per-minute time logs required for each patient | No per-minute time logs (standard care documentation still applies) |
| Payment structure | Flat fee per code once the time threshold is met | Risk-stratified (3 tiers scaled to patient complexity) |
| Billing codes | CPT 99490, 99439, 99487, 99489 | HCPCS G0556, G0557, G0558 |
| Quality reporting | Not required | Required for MIPS-eligible clinicians |
| Best fit | Patients who already have two or more chronic conditions | Your whole Medicare panel |
Why Practices Are Taking a Closer Look at APCM
- It reaches your whole panel. With CCM, patients who do not have two qualifying conditions are left out. APCM lets you manage and be paid for nearly every Medicare patient you see.
- There is no stopwatch. APCM pays based on the services you make available, not the minutes you log. You still document the care you provide, but you are freed from minute-by-minute tracking.
- The revenue is more predictable. Flat monthly payments tiered to patient complexity are easier to forecast than time-based billing that depends on hitting a threshold each month.
- It is built for where Medicare is headed. The CMS Advanced Primary Care Management Model brings together elements of several older programs and pairs payment with quality reporting. For 2026, CMS even added new add-on codes (G0568, G0569, and G0570) to reward behavioral health integration directly within this model.
So, Which Is the Right Fit?
There is no one-size-fits-all answer, but a few guidelines help.
CCM may still make sense if your care management program is built around a defined group of patients with multiple chronic conditions, and you have the staff and workflows to track time reliably.
APCM is often the stronger long-term move if you want to extend care management across your entire Medicare population, simplify documentation, and align with value-based care. One important note: in general, you cannot bill APCM and CCM for the same patient in the same month, so most practices choose one path per patient rather than running both. A patient can move between programs over time, but each program requires its own patient consent.
The eClinicalWorks Advantage
eClinicalWorks supports both CCM and APCM fully integrated within the same platform, so you can run both programs while billing only one per patient each month.
The eClinicalWorks Advanced Primary Care Management module is built to make those workflows compliant and efficient. It empowers your practice to manage APCM patients with ease and accuracy, covering every step from eligibility verification to batch claim generation.
What that looks like for your team:
- Centralized patient dashboard: View and manage your entire APCM panel in one place.
- Eligibility verification: Identify attributed APCM patients instantly and onboard them faster.
- Consent management: Capture and track patient consent electronically.
- Structured documentation: Keep accurate, up-to-date patient records and coordinate across care teams.
- Care planning tools: Create and manage personalized care plans that drive timely follow-ups and better outcomes.
- Automatic QMB status identification: Flag QMB patients to ensure compliant billing and the correct payment level.
- Batch claim generation: Generate claims for all eligible APCM patients at once, instead of one by one.
The result is less administrative work, fewer billing errors, and stronger care coordination. Read our value-based care brochure to see exactly how this works.
Staying Compliant as Codes Change
Medicare codes, requirements, and payment rates are updated regularly. Always confirm the current rules and rates with CMS and your payers before making billing decisions. (This article is for educational purposes and is not billing, coding, or legal advice).
The good news is that you do not have to track every coding change on your own. As updates roll out, eClinicalWorks automatically applies them within each program, keeping your billing accurate so your team can stay focused on patient care.
Ready to Move Forward?
See how APCM can expand your eligible population and simplify your billing. eClinicalWorks helps practices put value-based care into practice. Schedule a demo with our team today.
