Reimbursement
$15.20
Threshold
N/A
2026 Status
Active
What is CPT Code G0556?
CPT G0556 is defined as: Advanced Primary Care Management (APCM) services, Level 1. This bundle covers comprehensive longitudinal care management for a patient with one chronic condition expected to last at least 12 months. It includes 24/7 access to care, systematic assessment, and coordination of services, serving as a replacement for standard CCM or PCM for eligible APCM participating practices.
This code is primarily used for ACPM services. It falls under the category of Care Management / APCM and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
Physician Effort
PE (Non-Fac)
Practice Expense
Malpractice
Risk Factor
Total RVU
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% efficiency adjustment. CMS created the APCM codes to incentivize longitudinal primary care, protecting their valuation from productivity-based cuts.
bundle integration
G0556 integrates elements of CCM and BHI into a simplified monthly payment, reducing the coding burden for primary care practitioners.
conversion factor
Utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
condition threshold
Patient must have exactly one chronic condition that is expected to last 12+ months or until death.
participation requirement
Practices must opt-in to the APCM model and meet the infrastructure requirements (e.g., electronic care plan, 24/7 access).
frequency
Billed once per calendar month.
patient consent
Annual verbal or written consent is required and must be documented in the medical record.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
NEW 2026 CODE. Replaces CCM for single-condition patients in APCM-eligible practices. Stackable with BHI add-ons.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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