APCM Care Plan Documentation Checklist for Billing Codes

Capture patient agreement for APCM services, including cost-sharing information for G0556 and G0557.

List all chronic conditions to justify code selection between G0556 (moderate) and G0557 (high complexity).

Confirm Qualified Medicare Beneficiary status to ensure G0558 is billed instead of G0556/G0557.

Record the face-to-face initiating visit for new patients or those not seen within the last 12 months.

Document SDOH assessments which are integral to the APCM care management model and patient risk profile.

Keep a current list of all active medical and behavioral health problems within the certified EHR.

Document a full review of medications, including dosage, frequency, and potential drug-to-drug interactions.

Establish specific, time-bound clinical goals for every chronic condition managed under the APCM service.

Record all interactions with specialists, community resources, and diagnostic facilities in the care plan.

Document specific instructions provided to the patient for self-management and symptom monitoring.

Record how patients reach clinicians after hours; AI call routing can automatically log these interactions.

Use AI phone system logs to document outreach after emergency department visits or hospital stays.

Note the patient's preferred contact method (phone, portal, or text) to streamline care management outreach.

Explicitly name the specific care team member responsible for the patient's ongoing management in the record.

Verify that the care plan is shared electronically with all providers involved in the patient's care.

Verify that CCM (99490), PCM, or TCM are not billed in the same month as APCM codes.

Check for appropriate modifiers if billing APCM alongside other E/M services on the same date of service.

Ensure APCM is billed only once per calendar month per patient across all participating providers.

Confirm POS 11 (Office) or the appropriate setting is correctly identified on the CMS-1500 form.

Prepare documentation systems for the 2026 behavioral health add-on codes G0568-G0570.