Advanced Primary Care Management (APCM) services combine elements of several existing care management and communication technology-based services that helps to simplify billing and documentation requirements while ensuring that patients have access to high-quality primary care services.These services are intended for physicians and non-physician practitioners (NPPs), such as nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) who are responsible for delivering and coordinating all of a patient’s primary care services.

At this time, a patient’s APCM enrollment and consent status is tracked by the manual addition and removal of the default ‘APCM Consent’ patient flag. This flag is able to be added through the same workflows as all other patient flags, either the patient record or any program worklist.

The presence of this flag can also be utilized to filter for a practice’s APCM patients within ThoroughCare’s worklists.

To create a Care Plan for APCM patients, a condition must be associated with the APCM program. These conditions/problems can then be viewed under the Summary of Care tab, or any other program tab that the problem may be associated with.

Note: To populate APCM-related Care Plans onto a patient’s Care Plan Report, the conditions must be associated with at least one other program that is selected to populate on the report. If a condition is not associated with another program, its Care Plan cannot be displayed in the report at this time.

CMS considers patients who are designated as Qualified Medicare Beneficiaries when reimbursing for Advanced Primary Care Management services. To indicate patients who are considered a Qualified Medicare Beneficiary, a default ‘QMB’ patient flag will be available to manually add to patient records.

ThoroughCare generates the month's APCM claims on the first day of the following month. Available APCM-related CPT codes include:

To generate a G0556 monthly claim on a patient:

To generate a G0557 claim:

To generate a G0558 claim:

Beginning January 1st, 2026, the following behavioral health add-on codes will be available to include on APCM claims: G0568, G0569, and G0570.

To attach an add-on code to a claim, search and/or filter for the desired APCM claims from the Billing & Claims Worklist, select the claim's corresponding checkbox(es), click on the 'Bulk Actions' dropdown, and select 'Modify Code'.

From the 'Modify code' modal, select the desired bulk action, 'Add Code' or 'Remove Code', and then choose the code that you wish to add or remove from your selected claim(s).

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Once the 'Modify code' modal is saved, a toaster notification will populate to give direct feedback on the success of bulk action performed by including the following details:

Incorrect Program: Indicates the number of selected claims that were not related to APCM.

Add-on Code Already Added: When attempting to attach an add-on code, this indicates te number of selected claims that are already associated with an add-on code.
​Code Not Added: When attempting to remove an add-on code, this indicates the number of claims that were not previously attached to the selected code.

Code Removed: Indicates the number of selected claims that the bulk action to remove an add-on code was successfully performed on.

Code Added: Indicates the number of selected claims that the bulk action to add an add-on code was successfully performed on.