First look at APCM data: Growth, modest reach, physician turnover for Medicare’s primary care bundle

Primary care practices that adopted Medicare’s Advanced Primary Care Management (APCM) bundled payment found a way to get paid for between-visit work that often went unpaid.

But a monthly copay is keeping many patients, and some practices, on the sidelines. And some physicians weren’t using the codes because they had not heard of them yet.

“APCM: Ensuring the Bundled Payment Delivers Better Health” is the newest analysis of one of Medicare’s newest efforts to bolster primary care. The report, based on Medicare claims data, was produced by the Primary Care Collaborative (PCC) in partnership with West Health Policy Center.

The U.S. Centers for Medicare & Medicaid Services launched the model in 2025. The PCC report and the study, “Primary Care Clinician Uptake of Medicare Advanced Primary Care Management Billing Codes” in Journal of General Internal Medicine, appeared to be the first comprehensive examinations of how physicians used the model in its first year.

In short: Use of APCM services grew 2.7-fold from the first quarter to the fourth quarter of 2025, outpacing earlier Medicare codes aimed at strengthening primary care. Among the claims, 93.6% originated from primary care specialties.

“It’s encouraging to see the early adopters in the primary care community are enthusiastic about this promising new approach,” PCC President and CEO Ann Greiner, M.C.P., said in a news release.

“APCM provides an opportunity for practices across the nation to expand services, spend more time with patients and build a whole-person approach that we’ve seen leads to better health,” she said.

But “overall reach remains modest,” the report said. APCM spending was $130.7 million in 2025, a small share of overall spending, and “is very likely to remain extremely small in the context of total Medicare expenditures,” the report said. In the fourth quarter of 2025, about 344,000 beneficiaries received APCM services, or 1.2% of Medicare fee-for-service beneficiaries.

How APCM works

CMS launched APCM on Jan. 1, 2025, as a monthly bundled alternative to billing separately for chronic care management, principal care management and transitional care management. Practices bill one of three codes based on patient complexity:

• G0556 for patients with one or fewer chronic conditions
• G0557 for patients with two or more chronic conditions
• G0558 for patients with two or more chronic conditions who are Qualified Medicare Beneficiaries (QMBs), a low-income group also enrolled in Medicaid

Unlike earlier care management codes, APCM does not require time tracking. Practices must obtain patient consent, offer 24/7 access and maintain a care plan, among other requirements.

First-year numbers

The PCC analyzed 2025 Medicare fee-for-service claims, surveyed its community and conducted five case studies of early adopters. The claims analysis found that in 2025:

• APCM accounted for 2.49 million beneficiary-months and $130.7 million in allowed spending
• 9,748 clinicians and 1,951 billing entities billed the codes at some point
• 93.6% of claims came from primary care clinicians, led by family medicine (33.6%), nurse practitioners (28.7%) and internal medicine (27.0%)
• The Level 2 code, G0557, accounted for about 80% of claims and 68% of allowed dollars

Newcomers drove most of the growth. Nearly two-thirds (63%) of the increase in volume from the first to the fourth quarter came from clinicians who were not billing APCM in the first quarter. At the same time, 12% to 16% of billing clinicians dropped out from one quarter to the next. The authors said limited early claims data make that turnover hard to explain.

The copay problem

Because APCM is a Part B service, patients without supplemental coverage owe coinsurance every month, about $3 for Level 1 and $10 for Level 2. QMBs pay nothing. About 13% of beneficiaries in Original Medicare lack supplemental coverage, according to the report.

In the PCC’s summer 2026 survey of 176 respondents familiar with APCM, 42% ranked collecting monthly copays as the biggest hurdle to implementing the services. Asked which single change Medicare could make to scale up adoption, 54% chose waiving copays for beneficiaries who lack supplemental coverage while holding billing clinicians harmless.

Alex Krist, M.D., a family physician who co-leads APCM implementation at Inova Primary Care in Northern Virginia, called beneficiary cost-sharing a “massive problem.”

“I think with the copayment we could get 30% to 40% of our patients to sign up. If they had no copayment, I think we could get 80% to 90% of our patients to sign up,” Krist said in the report. He also participated in a reactor panel that met in person as part of PCC’s study rollout, which also was webcast.

Many patients enroll once they hear the program helps the practice hire staff, Krist said, but the exchange “makes the clinicians feel like they are selling something to their patients.”

At one anonymous safety net health system in the report, patients accepted team-based services but declined once a copay and unknown deductible were mentioned. That system paused its APCM rollout.

Independent practices

Krist’s practice in Virginia was among five case studies of early APCM adoption, featured in the report.

Jason Lofton, M.D., founder and medical director of Lofton Family Clinics, has run an independent rural practice in De Queen, Arkansas, for nearly 20 years.

“I see the problems with fee-for-service, particularly the pace at which you have to see patients to make the economics work. Patients want more time with us. We want more time with patients,” Lofton said in the report.

Some of his patients balk at coinsurance for months when they had no visit, so Lofton explains the program directly.

“I’m real upfront. I tell the patients about what the payment is, how it helps us, how it can help them,” he said.

According to the report, Lofton does not expect APCM payments alone to transform his practice. He pairs them with remote patient monitoring and shared savings from an Aledade-sponsored Medicare accountable care organization (ACO).

Community Care of North Carolina, a clinically integrated network, offers independent practices clinical support, technology tools and consent scripts, because some cannot afford an extra medical assistant.

“If I can prevent a single significant inpatient event, it likely pays for a year’s worth of APCM services for multiple patients,” said Sam Hiatt, Pharm.D., former director of Medicare program operations for the network.

The publicity problem

Barriers to use were cited by 41.6% of respondents to the survey reported in the Journal of General Internal Medicine study, of which Greiner was a co-author. The survey found 14.9% of respondents used APCM codes, but 43.6% of respondents were code non-users who had never heard of APCM codes.

“Our first-look study of APCM uptake suggests considerable room for growth and points to opportunities for education and coaching to help clinicians deliver and appropriately bill APCM services,” that study said.

Policy fixes

The PCC called on CMS and Congress to make APCM adoption easier by acting to:

• Remove burdensome beneficiary cost-sharing
• Simplify the consent and re-consent process for APCM and care documentation
• Create incentives for multipayer alignment across Medicare, Medicaid and other payers

Congress could take the broadest approach by designating APCM as a preventive service, as it did for the Annual Wellness Visit, the report said, because waiving the cost-sharing requires congressional action. The report also noted that the proposed 2027 Medicare Physician Fee Schedule would let ACOs and their participating clinicians waive beneficiary coinsurance for certain Part B services.

The PCC also urged policymakers to treat APCM as an on-ramp to accountable care, including hybrid payment, which combines prospective, population-based payment with fee-for-service.

“Year after year, our broken fee-for-service health system has consistently undervalued primary care,” Greiner said.

“APCM can and should be a first step toward a new system that empowers primary care to build the holistic, longitudinal relationships we know keep people healthy,” she said.