Focus on what truly drives your practice, better outcomes, value-based readiness, and predictable recurring revenue. With the right team, technology, and expertise, your APCM program can deliver scalable, compliant, and high-impact care.
Advanced Primary Care Management (APCM) is a CMS-aligned care model that enables physician groups to deliver continuous, longitudinal care beyond traditional visits, while generating recurring monthly reimbursement.
APCM works by combining care coordination, preventive care, and ongoing patient engagement into a structured program that supports patients across their entire care journey without requiring face-to-face visits for every interaction.
With Circle Health, you can operationalize APCM through:
Deliver continuous, whole-person care while unlocking monthly CMS-aligned reimbursement. APCM enables physician groups to move beyond episodic visits and build longitudinal, relationship-driven care models.
Whether you're transitioning to value-based care or expanding existing programs like CCM and RPM, Circle Health helps you streamline operations, ensure compliance, and maximize revenue potential.
Capture and document non-face-to-face care activities aligned with CMS guidelines to support accurate, recurring reimbursement.
Integrate with your EHR to streamline patient identification, enrollment, care coordination, and secure messaging.
HIPAA-compliant infrastructure with secure data exchange, audit-ready documentation, and role-based access controls.
APCM is billed using the following CMS codes (monthly, per patient):
These codes can be billed once per patient per month, creating a predictable and scalable revenue stream for physician groups.
For patients with ≤1 chronic condition.
For patients with 2+ chronic conditions.
For patients with 2+ chronic conditions and Qualified Medicare Beneficiary (QMB) status.
AI-powered value-based care programs
Leverage intelligent workflows to identify patients eligible for APCM based on risk, utilization, and care needs. Integrate with EHR data to streamline enrollment and onboarding.
Automated workflows ensure proper documentation, consent management, and adherence to CMS requirements, keeping your APCM program audit-ready at all times.
Create and manage dynamic care plans tailored to each patient's medical history, risk profile, and evolving needs supporting continuous engagement beyond visits.
Use AI-driven insights to identify care gaps, predict risks, and guide timely interventions improving outcomes and reducing avoidable utilization.
APCM enables reimbursement for ongoing care management activities performed outside traditional visits, creating predictable monthly revenue streams aligned with value-based care.
Track all patient interactions, care coordination efforts, and engagement activities in one system, ready for accurate reporting and streamlined billing.
Understand how APCM works, including care delivery workflows, billing codes, and revenue potential for physician groups.
Understanding value-based reimbursement for APCM
Unlike standalone programs, APCM integrates multiple care management services into a comprehensive, scalable reimbursement model.
APCM enables physician groups to transition toward value-based care by delivering continuous, coordinated care that improves outcomes while generating recurring revenue from non-visit-based services.
APCM supports proactive, longitudinal care through regular engagement, care coordination, and personalized care plans helping reduce hospitalizations and improve adherence.
APCM is ideal for Medicare and high-risk patient populations who benefit from continuous care management, preventive care, and coordinated interventions.
While CCM focuses on chronic conditions and RPM on device-based monitoring, APCM provides a holistic, longitudinal care model that integrates both and expands across the full patient journey.
Yes. Circle Health ensures all APCM workflows, documentation, and reporting align with CMS guidelines, maintaining full compliance and audit readiness.