Reimbursement
$48.84
Threshold
N/A
2026 Status
Active
What is CPT Code G0557?
CPT G0557 is defined as: Advanced Primary Care Management (APCM) services, Level 2. This bundle covers comprehensive longitudinal care management for patients with two or more chronic conditions expected to last at least 12 months. It requires a comprehensive care plan, 24/7 access to urgent clinical guidance, and systematic coordination of care. It serves as the primary management code for multimorbid primary care patients in the APCM model.
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 views APCM Level 2 as the foundation of value-based primary care and has protected its valuation to support practice transformation.
transition opportunity
G0557 provides a higher-value alternative to standard CCM (99490) for practices that commit to the advanced APCM infrastructure requirements.
conversion factor
Utilizes the 2026 Non-QP baseline of $33.40.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
condition threshold
Patient must have two or more chronic conditions expected to last 12+ months or until death.
care plan requirement
A comprehensive, electronically accessible care plan must be established and shared with the patient and other relevant providers.
access requirement
The practice must ensure 24/7 access to a clinician who can provide urgent clinical guidance.
frequency
Billed once per calendar month.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
NEW 2026 CODE. Replaces CCM for multimorbid patients in APCM-eligible practices. Stackable with APCM 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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