Carematix makes it easier than ever to provide better remote patient care while driving improved patient outcomes. Our end-to-end remote care management solution and connected ecosystem allows remote care teams to work efficiently and effectively no matter how many patients they serve. Learn how to keep patients engaged and healthy while increasing your bottom line with reimbursable care management programs.
Advanced Primary Care Management is a billable service that is new in 2025. APCM services encompass patient assessments, individualized care plans, continuous care coordination and non-vist based care. Reimbursement rates are determined by the complexity or number of chronic conditions instead of time spent. APCM can be billed in conjunction with RPM, but not with CCM.
A reimbursable service in which healthcare providers monitor patients using connected devices (Blood Pressure Monitors, Weight Scales, Glucometers etc) to securely capture patient biometric data from the comfort of their home. This allows providers to extend care beyond clinic visits and make real-time, data-driven
treatment decisions. The 16-day requirement applies to 99453 / 99454 but doesn’t apply to 99457 / 99458 (treatment management).
| HCPCS Code | Description | Monthly Rate |
|---|---|---|
| CPT 99453 | Initial patient set up and education on use of equipment, can be done remotely by practice staff. When at least 16 days of data have been collected on at least one medical device. | $21 |
| CPT 99445 (NEW 2026) |
|
$51 |
| CPT 99454 | Remote monitoring (data review) of provider-supplied device with daily recording or programmed alert transmission, 16 unique days each 30 days | $51 |
| CPT 99470 (NEW 2026) |
|
$26 |
| CPT 99457 | RPM treatment management services, first 20 minutes of clinical staff/QHP time (under general supervision) in a calendar month. Requires one interactive communication with the patient/caregiver | $52 |
| CPT 99458 | Each additional 20 minutes of clinical staff/other QHP time (under general supervision) in a calendar month. Requires one interactive communication with the patient/caregiver | $40 |
In a departure from its focus on billing codes tied to transactional-based services, CMS has introduced new billing codes for Advanced Primary Care Management (APCM) services designed to encourage a more comprehensive and value-centric approach to patient care management.
However, in a major shift from time requirement rules in these codes, there are no time threshold or tracking requirements for APCM. The APCM codes are divided into three levels as summarized in the table below.
| HCPCS Code | Description | Monthly Rate |
|---|---|---|
| G0556 (Level 1) | Clinical staff provides services meeting all the required elements of APCM services, for any patient, under guidance of a physician or qualified health professional responsible for the patient’s primary care needs | $15.20 |
| G0557 (Level 2) | Services as described in G0556, for a patient with at least two chronic conditions expected to last at least 12 months, or until the death of the patient | $48.84 |
| G0558 (Level 3) | Services as described in G0557 for a patient that is a Qualified Medicare Beneficiary | $107.07 |
| Number of Patients | Month One Revenue | Months 2+ Revenue | Annual Revenue |
|---|---|---|---|
| 25 | $4,000 | $3,500 | $42,500 |
| 50 | $8,000 | $7,000 | $85,000 |
| 100 | $16,000 | $14,000 | $170,000 |
| 200 | $32,000 | $28,000 | $340,000 |
| 1000 | $160,000 | $140,000 | $1,700,000 |
Above illustration assumes a combined RPM and APCM Level 2 program for eligible Medicare patients
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