If your practice manages patients with chronic conditions, Medicare offers several ways to get paid for the work you already do between visits, and two of the most common are Chronic Care Management (CCM) and the newer Advanced Primary Care Management (APCM). They cover similar ground, but they are billed in almost opposite ways. Choosing the right one is often the difference between a program that runs itself and one that quietly dies under documentation.
How CCM works
CCM has been around since 2015 and is billed with 99490 for the first 20 minutes of non-face-to-face care coordination per month, with add-on codes for additional time. It reimburses well, but the catch is in that word minutes: someone has to track and document at least 20 minutes of qualifying time every month, for every enrolled patient.
- Time-based: you bill on documented minutes.
- Strong per-patient revenue when the time is captured.
- The overhead is the time log. Miss it, and you cannot bill.
How APCM works
APCM launched in 2025 and replaces the stopwatch with a set of service elements. It is billed monthly with three codes based on patient complexity:
- G0556, for patients with zero or one chronic condition (the lowest of the three levels)
- G0557, two or more chronic conditions
- G0558, two or more chronic conditions for a Qualified Medicare Beneficiary
Instead of logging minutes, your practice attests that it can deliver a defined set of advanced primary care services, including 24/7 access and continuity of care, comprehensive care management, an electronic patient-centered care plan, coordination of care transitions, enhanced communication, and patient population-level management. Billing practitioners also need patient consent and must report quality performance through the primary care MIPS Value Pathway. No time tracking.
So which one should you bill?
The honest answer is: it depends on where your friction is.
- Choose APCM if minute-tracking is what has kept you from running a care-management program at all. The documentation burden is lower, the revenue is steady and predictable, and it scales across a panel without a time log per patient.
- Choose CCM if you have patients who genuinely consume heavy monthly coordination time and you already have a workflow that captures minutes reliably. For those patients, time-based billing with add-on codes may better reflect the work.
Some practices may land on a mix: APCM as the default for the broad chronic panel, CCM reserved for the highest-touch patients. What you cannot do is have the same practitioner bill both APCM and CCM for the same patient in the same month, so the decision has to be made patient by patient.
The real barrier is not the code
For most independent practices, the reason care-management dollars go uncaptured is not the choice between APCM and CCM. It is that nobody has the time to identify eligible patients, keep the care plans current, and make sure the billing actually goes out every month. The codes are generous; the operations are the hard part.
How SmartOps Health helps
SmartOps Health flags every patient who qualifies for APCM or CCM, keeps the care plans and service elements documented, and makes enrolling a patient a one-tap action instead of a project. You capture the recurring revenue without adding a full-time coordinator to do it.
Want to see which of your patients qualify right now? See the platform.