FQHC APCM Billing Code Setup Checklist

Coordinate with your billing department to ensure APCM codes (G0511/G0512) are correctly mapped to your PPS encounter logic.

Update your Electronic Health Record templates to capture the specific requirements for Advanced Primary Care Management codes.

Ensure that APCM services are integrated into your health center's sliding fee scale for patients below 200% of the FPL.

Review how APCM revenue will be categorized on the Medicare Cost Report to avoid double-counting with PPS costs.

Add the specific APCM billing codes to your facility's chargemaster with appropriate internal pricing for cost reporting.

Set up reporting to track APCM revenue generation by individual providers to monitor health center productivity.

Use AI call agents to reach out to diverse patient populations in their native languages to obtain APCM consent.

Implement software that automatically logs time spent by staff and AI systems on non-face-to-face care coordination.

Configure AI phone systems to screen for social determinants of health during routine chronic care check-ins.

Ensure patients have 24/7 access to care management resources via AI-driven phone automation as required by APCM.

Automate the transfer of patient interaction summaries from the AI call center directly into the EHR for documentation.

Use AI to trigger follow-up calls based on patient responses or missed clinical milestones in the care plan.

Ensure that the data captured during APCM interactions feeds directly into your Uniform Data System (UDS) reports.

Confirm that all APCM activities fall within your HRSA-approved Form 5A: Services Provided scope of service.

Maintain a verifiable log of patient consent for AI-driven phone outreach and digital care coordination services.

Use APCM data to improve performance on HRSA clinical quality measures like hypertension and diabetes control.

Establish a workflow to ensure APCM is not billed for patients who had a qualifying PPS encounter on the same day.

Consult with a specialist to ensure APCM staff time is properly allocated on the annual cost report to maintain PPS rates.