Why It Matters: By 2030, CMS expects practices to transition into whole-patient, value-based models, such as APCM. Early adoption means higher reimbursement, better audit readiness, and improved outcomes. Waiting means insurers may push value-based care on their terms, leaving less time to prepare.

• AWV Framework focuses on yearly patient intake and care planning
• APCM expands the front door to include consistent monthly whole-patient care, ensuring that medications, vitals, referrals, and care goals are addressed and billed every month.

Why It Matters: By 2030, CMS expects practices to transition into whole-patient, value-based models, such as APCM. Early adoption means higher reimbursement, better audit readiness, and improved outcomes. Waiting means insurers may push value-based care on their terms, leaving less time to prepare.

APCM Service Elements

To bill Advanced Primary Care Management (APCM), CMS requires that specific service elements be completed and documented on a monthly basis. These elements ensure the patient is receiving whole-patient care rather than just fragmented chronic management.

The core service elements include:

• Medication Review – reconciling prescriptions, checking adherence, and updating care plans.

• Care Goals – establishing or reviewing patient-centered goals and documenting progress.

• Vitals & Monitoring – reviewing home readings (via RPM if used) and addressing out-of-range results.

• Transitions of Care – managing recent hospital, SNF, or rehab discharges to prevent readmissions.

• Referrals & Follow-Ups – coordinating with specialists, therapy, or community resources.

• SDOH & Behavioral Health – assessing social needs and integrating behavioral health screenings when appropriate.

• Documentation & Communication – capturing time, patient consent, and two-way communication to ensure CMS audit compliance.

In plain terms: APCM requires practices to show they’ve addressed the whole patient every month — meds, vitals, goals, transitions, and referrals — with clear documentation that ties back to the AWV Framework (AWV, HRA, SDOH, ACP).

How RPM Works with APCM

Remote Patient Monitoring (RPM) can be billed together with APCM because CMS considers RPM a separate, distinct service.

• RPM covers the device supply, data transmission, and 20+ minutes of monitoring/interaction each month (codes 99453–99458).
• APCM, on the other hand, requires service elements like medication review, vitals review, care goals, and transitions of care.

The vitals you collect from RPM can support APCM documentation, but you must avoid double counting the same time toward both RPM and APCM minutes.

In practice:

• Document RPM minutes separately for 99457/99458.
• Document APCM service elements (care goals, meds, transitions, referrals, SDOH) distinctly.
• Use RPM data to inform APCM care decisions, but keep the billing documentation clean.

Our APCM solution isn’t just software — it’s a more innovative way to deliver whole-patient care. Our unique AI-driven workflows streamline service element requirements, keep APCM and RPM documentation clean, and help you stay compliant while freeing your staff to focus on patient care—the result: less administrative burden, stronger reimbursements, and better outcomes.

We’re excited to show you how simple APCM can be when the hard work is handled behind the scenes. Contact us today to discover HCUnity’s Health Path and explore the possibilities for your practice.

To match different patient needs, CMS created three new billing codes for APCM services. These payment tiers recognize that patients with more complex health or social challenges often require more time, communication, and coordination. APCM makes it easier for practices to provide that care and be fairly paid for it.

Moving your more complex CCM patients to APCM, while retaining less critical conditions in CCM, is an excellent strategy for compliance and your bottom line.

• Whole-patient oversight: APCM requires a complete picture every month — meds, vitals, transitions, care goals, behavioral health, SDOH. This ensures higher-risk patients get the full attention they need

• Better outcomes: Complex patients often have multiple conditions, undergo frequent hospital transitions, and face medication challenges. APCM provides structure to reduce ER visits and readmissions.

• Appropriate intensity of care: Lower-risk patients can remain in CCM, where lighter chronic management still earns reimbursement without overburdening staff.

• CMS alignment: By 2030, CMS expects practices to deliver whole-patient, value-based care. Moving high-risk patients into APCM shows early compliance.

• Cleaner documentation: APCM workflows make it easier to track service element requirements (vitals, meds, referrals, care goals). This reduces audit risk compared to piecemeal CCM notes.

• Segmentation clarity: Distinguishing “light” vs. “complex” patients creates a clear, defensible logic for billing different codes.

• Higher reimbursement: APCM pays more per patient than CCM, reflecting the complexity of care. Shifting complex patients maximizes monthly revenue.

• No loss of RPM revenue: APCM doesn’t replace RPM — it complements it. RPM billing continues on top of APCM.

• Time efficiency: APCM’s structured workflows reduce wasted staff effort chasing 20+ CCM minutes that don’t always get billed.

• Scalable growth: As more patients transition to APCM, the practice establishes a sustainable, predictable revenue stream.

• AI-driven efficiency: Automated service-element prompts keep staff on track without manual oversight.

• Burnout reduction: Staff spend less time fighting documentation and more time caring for patients.

• Team flexibility: Practices can assign simpler CCM tasks to junior staff while reserving APCM oversight for RNs, pharmacists, or physicians.

Moving complex chronic patients from CCM into APCM ensures they get the full scope of care, keeps your billing compliant, increases revenue, and reduces staff burden. Keeping less critical chronic patients in CCM prevents over-documentation and balances workload — giving you the best of both worlds.