Review 2025 billing changes affecting provider-delivered care management services

Here’s a summary of 2025 billing changes that affect provider-delivered care management services for Medicare Plus Blue℠ and BCN Advantage℠ members.

Advanced primary care management services

For 2025, the following HCPCS codes have been added for advanced primary care management, or APCM, services:

• G0556
• G0557
• G0558

These HCPCS codes:

• Are billable only for Medicare Advantage members who meet criteria
• Were approved in the Centers for Medicare & Medicaid Services final rule in November 2024

The HCPCS codes for APCM services are considered duplicative with procedure codes for chronic care management, principal care management, provider-delivered care management and transitional care management services. As a result, the APCM codes aren’t payable in the same month as the CCM, PCM, PDCM or TCM codes.

Note: The new codes for APCM aren’t included in Blue Cross Blue Shield of Michigan or Blue Care Network’s PDCM program.

Important: HCPCS codes G0556, G0557 and G0558 aren’t payable for Blue Cross or BCN commercial members.

Rural health clinics and federally qualified health clinics

As outlined by CMS, billing will change as follows for Medicare Advantage members who receive care management services at RHCs or FQHCs.

Medicare Advantage members who receive the above services at RHCs or FQHCs aren’t included in the denominator for our PDCM program.