Primary Care Clinician Uptake of Medicare Advanced Primary Care Management Billing Codes.

BACKGROUND

In January 2025, Medicare introduced Advanced Primary Care Management (APCM) fee codes, the most substantial of recent Medicare reforms intended to better value the work of comprehensive primary care and lower administrative barriers to uptake of new codes. The highest tier APCM code could potentially bring more than $1200 annually per beneficiary in additional Medicare payment to a primary care practice.

OBJECTIVE

To assess uptake of APCM codes by primary care clinicians.

DESIGN

Cross-sectional survey administered in December 2025.

PARTICIPANTS

Convenience sample of US primary care clinicians in patient care (N = 404).

MAIN MEASURES: Self-reported use of APCM codes and reasons for not-using.

KEY

RESULTS

60 respondents (14.9%) reported using APCM codes, 176 (43.6%) were non-users who reported that they had never heard of APCM codes, and 168 (41.6%) were non-users who reported a specific barrier to billing APCM codes. Among the 168 respondents reporting barriers to use, the most frequently cited administrative barriers were not understanding documentation required (53.0%), EHR issues (38.1%), and administrative burden (33.3%).

CONCLUSIONS

Although substantial increases in revenue are now available to primary care clinicians serving Medicare beneficiaries by appropriately billing for APCM services, a relatively small proportion of this national sample of primary care clinicians used APCM codes during the first year of availability. Our results suggest a major opportunity for Medicare, healthcare organizations, and professional societies to educate and coach clinicians to overcome the relatively low administrative barriers to appropriately billing APCM codes.