The healthcare industry is undergoing big changes now that the Centers for Medicare & Medicaid Services have introduced new Advanced Primary Care Management codes in the 2025 Physician Fee Schedule. This shift focuses on expanding virtual care, prioritizing patient-centered approaches, and adopting technology to meet the changing needs of healthcare.
In this article, you’ll learn about the new opportunities from the updated Physician Fee Schedule, strategies for clinicians to improve remote care, and best practices for effective virtual consultations.
Key Takeaways
The 2025 Physician Fee Schedule introduces new Advanced Primary Care Management codes, expanding virtual care and prioritizing patient-centered approaches.
- Three new HCPCS codes (G0556, G0557, and G0558) for APCM aim to improve care management using digital tools, focusing on consistent communication and proactive care.
- The new codes allow non-physician practitioners to bill for services if they are responsible for the patient’s overall primary care, improving access to care and patient outcomes.
- Effective strategies for virtual care include secure communication channels, patient engagement and education, standardized protocols for virtual evaluations, and technological investments and training.
New HCPCS codes
In the new Physician Fee Schedule, CMS has introduced three new HCPCS codes for APCM. These codes aim to improve care management using digital tools. This change encourages providers to use technology to make patient care better and more effective.
The new APCM codes—G0556, G0557, and G0558—change how primary care is provided, focusing on consistent communication and proactive care. Unlike previous codes like Chronic Care Management and Principal Care Management, these new codes aren’t based on time, which means you can bill monthly without worrying about meeting specific time requirements. These codes cover a variety of services, such as video calls, remote check-ups, and talking to patients through secure online platforms, making care more complete and easier to access.
This initiative shows CMS’s dedication to promoting care focused on the patient. By encouraging providers to use a more proactive care model, healthcare professionals can meet patients’ needs at times and places that work best for them. This improves access to care and patient outcomes. The new codes also allow non-physician practitioners, like nurse practitioners and physician assistants, to bill for these services if they are responsible for the patient’s overall primary care.
The APCM codes make billing easier and improve care by using advanced care management. They blend existing codes with Communication Technology-Based Services, allowing providers to engage with patients more holistically, focusing on ongoing care rather than one-time treatments.
The Center for Medicare & Medicaid Services released the final version of the Physician Fee Schedule. This includes three new codes for APCM. These codes will start being used on January 1, 2025.
In the past ten years, the CMS Innovation Center has tried out more than 50 different ways to pay for and deliver healthcare, with the goal of keeping costs stable and improving quality. As part of the Health and Human Services’ effort to strengthen primary health care, CMS looked back at the primary care programs that worked best. Their review showed that primary care providers need extra compensation for care management and coordination work done outside of regular visits, leading to the creation of three new APCM codes.
The three APCM codes have similar requirements for billing, but they differ based on how complex the patient’s needs are:
Level 1 (HCPCS G0556): For patients with one or no chronic conditions.
Level 2 (HCPCS G0557): For patients with two or more chronic conditions.
Level 3 (HCPCS G0558): Qualified Medicare beneficiaries.
Billing the APCM codes
To bill the APCM codes, these needs must be met:
Patient consent: Tell the patient about the services, their right to stop them, and any costs they might incur.
Initiating visit: Needed for new patients or those not seen in the last three years.
24/7 access and continuity of care: Team members must be available for urgent needs, ensuring smooth, continuous care.
Comprehensive care management: Assess needs, ensure preventive services are given, manage medications, and help patients with medication management.
Patient-centered care plan: Keep it updated, share it with the care team, and give a copy to the patient and/or caregiver.
Managing care transitions: Share health info quickly and follow up care after ER visits and hospital stays.
Coordinated care: Work with specialists and other healthcare groups through agreements and online consultations.
Better communication options: Allow patients and caregivers to connect with team members in more ways.
Manage patient population: Oversee preventive and chronic care and implement plans to improve results for patients.
Performance measurement: Track quality, care costs, and effective use of electronic health records.
Effective strategies for virtual care
The expansion of virtual care offers both exciting opportunities and challenges for healthcare providers. To take full advantage of the new APCM model, clinicians need to use effective strategies that maintain high-quality care, even when patients aren’t physically present. Here are some key tips for delivering remote care effectively:
Secure communication channels: Setting up secure communication channels between clinicians and patients is essential for successful remote care. Because healthcare data is sensitive, it’s crucial to use platforms that follow privacy rules like HIPAA. Tools like secure video calls, encrypted messaging, and patient portals help keep patient information private during virtual visits.
Patient engagement and education: Engaging patients and encouraging them to take part in their own health management is important in virtual care settings. Digital tools like online portals and mobile apps allow patients to be involved in their care, access health information, and communicate with their providers. This helps improve adherence to treatment plans and leads to better health outcomes.
Additionally, providers should educate patients on using virtual consultation platforms, dealing with technical issues, and feeling at ease discussing health concerns remotely. Educating patients helps overcome barriers to virtual care and ensures a smooth experience for both patients and providers.
Standardized protocols for virtual evaluations: Using standardized protocols for remote evaluations can greatly improve the quality and efficiency of virtual care. Clinicians should have clear steps for conducting remote consultations, from initial assessments to follow-ups. These steps should cover everything from how to position the camera during video calls to asking the right questions for a complete evaluation of the patient’s condition.
Virtual consultation preparation tips
Giving virtual care effectively needs both providers and patients to be ready. With new APCM codes coming in, healthcare providers have to not only get the right technology but also prepare themselves and their patients for this care.
Technological investments and training: Providers need to invest in technology to give good virtual care. Things like Electronic Health Records with telemedicine, good video call tools, and secure ways to communicate are crucial for successful remote care. Also, training staff to use these tools and solve common tech problems during virtual sessions is important.
It’s important to keep up with best practices for virtual care too. This includes learning how to build good relationships with patients during video calls and how to do proper evaluations remotely. By making sure clinicians are comfortable with technology, practices can blend virtual care smoothly into regular patient management.
Educating patients for success: Patients also need to be prepared for virtual visits to have a good experience. Providers should show patients how to use the platforms, access telehealth services, and get ready for virtual appointments. This includes simple steps to set up video calls, fixing connection problems, and helping patients prepare questions in advance for the consultation to be effective.
Managing care continuity and transitions: Keeping care continuous is key to successful virtual care. Providers need to make sure patients receive consistent care wherever they are. This means having dedicated care teams for healthcare needs and easy transitions between in-person and virtual care when needed.
For example, after an emergency room visit or hospital discharge, follow-up care through virtual consultations can provide necessary support during recovery. Care plans should be easy for patients to access and regularly updated to allow for effective communication and coordination among everyone involved in the patient’s care.
