Get Paid for the Care You’re Already Providing: How Advanced Primary Care Management (APCM) is Reshaping Revenue for Primary Care Practices

Unlocking Hidden Revenue: How APCM Turns Everyday Primary Care Into Monthly Medicare Payments

Advanced Primary Care Management (APCM) is a groundbreaking CMS payment model that enables primary care providers to receive recurring monthly payments for non-office-based care coordination. Unlike traditional fee-for-service billing, APCM compensates providers for essential services they already deliver—such as medication management, lab follow-ups, patient education, and care coordination with specialists. This model not only reduces administrative burden but also makes it easier for practices to support patients with chronic conditions while generating sustainable revenue. APCM redefines how value-based care is delivered by transforming routine, previously unreimbursed tasks into a predictable income stream.

Understanding APCM Payment Tiers

CMS structured APCM payments around three tiers of patient complexity, creating a straightforward way to capture revenue for services already being delivered:

Tier	Patient Type	Monthly Payment
Tier 1	Medicare with 1+ chronic conditions	~$15
Tier 2	Moderate complexity (most common)	~$50
Tier 3	High complexity or QMB patients	Up to $110
FQHCs	Use G codes	Alternative billing path

These tiers reflect the increasing clinical effort and coordination needed as patient complexity rises. For example, a Tier 3 patient may require ongoing education, medication titration, and collaboration across multiple specialists—work that was previously uncompensated under traditional models.

APCM vs. CCM: What's the Difference?

APCM is often described as a "better version of CCM," and for good reason. It removes many of the barriers that make chronic care management frustrating for small and midsize practices. 

Furthermore, APCM expands the pool of eligible Medicare patients by requiring only one chronic condition, compared to the two required for CCM. It also opens the door for patients without chronic conditions who still need ongoing care management to qualify.

Comparison: Chronic Care Management (CCM) vs. Advanced Primary Care Management (APCM)

Feature	CCM	APCM
Eligible Providers	Any specialty	Primary care only
Time Requirements	20+ minutes/month	No time requirement
Consent Needed	Written only	Verbal or written
Documentation Burden	High	Low
Monthly Reimbursement	~$62	$15–$110
Flexibility	Often tied to third-party services	Practice-led with software support
Billing Simplicity	Complex	Streamlined 3-tier model

Why Now is the Time to Act

Because APCM is still relatively new, many primary care providers are unaware of its benefits. But those who act now can gain a first-mover advantage—transforming underutilized workflows into a recurring, scalable revenue stream that aligns with value-based care goals.

Organizations like ReportingMD are helping practices identify eligible patients, automate documentation, and ensure compliance with CMS rules—turning APCM from a complex policy into a turnkey solution for practice growth.

According to Dr. Larry Blosser, Chief Medical Officer at ReportingMD and quality care advocate:

“Practices are already doing this work—it’s time they got paid for it.”