$15.01–$20.72
Choose G0557 for the level 2 patient criteria, including two or more qualifying chronic conditions; G0556 is the lower level for one qualifying chronic condition.
On this page
CMS RVU26D · Effective 2026-10-01
G0557 Primary care management Medicare reimbursement rates
G0557 reports monthly advanced primary care management for a patient with two or more qualifying chronic conditions receiving coordinated, comprehensive primary care. Compare G0557 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0557?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$49.24–$67.60
109 of 109 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where G0557 pays more and less
109 payment localities
$49.24 to $67.60
Care management
About G0557: Advanced primary care management, level 2
G0557 reports monthly advanced primary care management for a patient with two or more qualifying chronic conditions receiving coordinated, comprehensive primary care.
G0557 represents a monthly package of advanced primary care management for a patient with two or more chronic conditions expected to last at least 12 months, or until the patient’s death, and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. A primary care physician or other eligible practitioner uses this approach to coordinate ongoing care across the patient’s conditions, providers, and settings. Work may include maintaining a care plan, coordinating referrals and transitions, supporting patient access and communication, and tracking population health needs.
Report the code for an eligible patient receiving the level 2 service, rather than selecting it according to staff time spent in a particular month. The record should support the chronic-condition criteria, the patient’s enrollment or agreement to receive the service, and the care-management and coordination work provided. Keep documentation showing how the practice addressed the patient’s ongoing needs, such as care-plan updates, communication, or coordination with other clinicians. G0557 is the middle level in the advanced primary care management code family; G0556 and G0558 distinguish other patient eligibility levels.
Where the value comes from
- Work RVU0.77 · 48%
- Practice expense (office) RVU0.79 · 49%
- Malpractice RVU0.05 · 3%
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
G0557 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$107.19–$147.06
G0558 is the higher APCM level and has an additional eligibility criterion beyond the two-or-more-condition basis for G0557.
$60.71–$83.76
G0557 represents the advanced primary care management model on a monthly basis; 99490 is time-based chronic care management and depends on meeting its monthly time threshold.
See how rates vary across the country
G0557 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$49.24
$67.60
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $67.60 | 1 |
| AL | $49.75 | 1 |
| AR | $49.24 | 1 |
| AZ | $52.72 | 1 |
| CA | $55.97–$67.49 | 29 |
| CO | $55.41 | 1 |
| CT | $56.67 | 1 |
| DC | $60.05 | 1 |
| DE | $53.42 | 1 |
| FL | $53.45–$57.41 | 3 |
| GA | $51.25–$54.61 | 2 |
| GU | $56.69 | 1 |
| HI | $56.69 | 1 |
| IA | $50.53 | 1 |
| ID | $50.78 | 1 |
| IL | $52.42–$56.25 | 4 |
| IN | $50.99 | 1 |
| KS | $50.41 | 1 |
| KY | $50.70 | 1 |
| LA | $50.67–$52.45 | 2 |
| MA | $55.25–$59.77 | 2 |
| MD | $54.21–$60.05 | 3 |
| ME | $51.03–$52.92 | 2 |
| MI | $51.70–$54.00 | 2 |
| MN | $53.36 | 1 |
| MO | $50.09–$52.51 | 3 |
| MS | $49.67 | 1 |
| MT | $53.77 | 1 |
| NC | $51.40 | 1 |
| ND | $52.78 | 1 |
| NE | $50.70 | 1 |
| NH | $54.65 | 1 |
| NJ | $57.39–$59.73 | 2 |
| NM | $51.92 | 1 |
| NV | $53.52 | 1 |
| NY | $51.96–$61.84 | 5 |
| OH | $51.49 | 1 |
| OK | $50.58 | 1 |
| OR | $53.17–$56.69 | 2 |
| PA | $51.52–$55.64 | 2 |
| PR | $54.04 | 1 |
| RI | $54.95 | 1 |
| SC | $51.52 | 1 |
| SD | $52.67 | 1 |
| TN | $50.60 | 1 |
| TX | $51.28–$55.17 | 8 |
| UT | $52.02 | 1 |
| VA | $52.84–$60.05 | 2 |
| VI | $54.04 | 1 |
| VT | $52.69 | 1 |
| WA | $55.11–$60.75 | 2 |
| WI | $51.51 | 1 |
| WV | $51.04 | 1 |
| WY | $53.34 | 1 |
Compare G0557 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $49.75 | Facility $32.22 |
| Alaska* | Office $67.60 | Facility $46.26 |
| Arizona | Office $52.72 | Facility $33.30 |
| Arkansas | Office $49.24 | Facility $32.03 |
| Atlanta | Office $54.61 | Facility $34.25 |
| Austin | Office $55.17 | Facility $33.96 |
| Bakersfield | Office $56.14 | Facility $34.18 |
| Baltimore/Surr. Cntys | Office $56.51 | Facility $35.01 |
| Beaumont | Office $51.28 | Facility $33.05 |
| Brazoria | Office $53.38 | Facility $33.52 |
| Chicago | Office $56.25 | Facility $36.11 |
| Chico | Office $55.97 | Facility $34.01 |
| Colorado | Office $55.41 | Facility $34.08 |
| Connecticut | Office $56.67 | Facility $35.09 |
| Dallas | Office $53.66 | Facility $33.70 |
| Dc + Md/Va Suburbs | Office $60.05 | Facility $36.44 |
| Delaware | Office $53.42 | Facility $33.62 |
| Detroit | Office $54.00 | Facility $34.66 |
| East St. Louis | Office $53.36 | Facility $34.92 |
| El Centro | Office $55.98 | Facility $34.01 |
| Fort Lauderdale | Office $55.47 | Facility $35.17 |
| Fort Worth | Office $53.42 | Facility $33.66 |
| Fresno | Office $55.97 | Facility $34.01 |
| Galveston | Office $53.51 | Facility $33.61 |
| Hanford-Corcoran | Office $55.97 | Facility $34.01 |
| Hawaii, Guam | Office $56.69 | Facility $33.90 |
| Houston | Office $54.42 | Facility $34.52 |
| Idaho | Office $50.78 | Facility $32.35 |
| Indiana | Office $50.99 | Facility $32.41 |
| Iowa | Office $50.53 | Facility $32.19 |
| Kansas | Office $50.41 | Facility $32.30 |
| Kentucky | Office $50.70 | Facility $32.89 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $59.10 | Facility $35.39 |
| Madera | Office $55.97 | Facility $34.01 |
| Manhattan | Office $60.67 | Facility $37.39 |
| Merced | Office $55.97 | Facility $34.01 |
| Metropolitan Boston | Office $59.77 | Facility $35.84 |
| Metropolitan Kansas City | Office $52.13 | Facility $33.31 |
| Metropolitan Philadelphia | Office $55.64 | Facility $34.78 |
| Metropolitan St. Louis | Office $52.51 | Facility $33.43 |
| Miami | Office $57.41 | Facility $36.55 |
| Minnesota | Office $53.36 | Facility $32.74 |
| Mississippi | Office $49.67 | Facility $32.42 |
| Modesto | Office $55.97 | Facility $34.01 |
| Montana** | Office $53.77 | Facility $33.73 |
| Napa | Office $62.97 | Facility $36.55 |
| Nebraska | Office $50.70 | Facility $32.21 |
| Nevada** | Office $53.52 | Facility $33.46 |
| New Hampshire | Office $54.65 | Facility $33.79 |
| New Mexico | Office $51.92 | Facility $33.54 |
| New Orleans | Office $52.45 | Facility $33.59 |
| North Carolina | Office $51.40 | Facility $32.71 |
| North Dakota** | Office $52.78 | Facility $32.74 |
| Northern Nj | Office $59.73 | Facility $36.48 |
| Nyc Suburbs/Long Island | Office $61.84 | Facility $38.01 |
| Ohio | Office $51.49 | Facility $33.20 |
| Oklahoma | Office $50.58 | Facility $32.68 |
| Oxnard-Thousand Oaks-Ventura | Office $58.67 | Facility $34.98 |
| Portland | Office $56.69 | Facility $34.42 |
| Poughkpsie/N Nyc Suburbs | Office $57.79 | Facility $35.85 |
| Puerto Rico | Office $54.04 | Facility $33.78 |
| Queens | Office $60.96 | Facility $37.27 |
| Redding | Office $55.97 | Facility $34.01 |
| Rest Of California | Office $55.97 | Facility $34.01 |
| Rest Of Florida | Office $53.45 | Facility $34.30 |
| Rest Of Georgia | Office $51.25 | Facility $33.37 |
| Rest Of Illinois | Office $52.42 | Facility $34.12 |
| Rest Of Louisiana | Office $50.67 | Facility $32.93 |
| Rest Of Maine | Office $51.03 | Facility $32.60 |
| Rest Of Maryland | Office $54.21 | Facility $33.93 |
| Rest Of Massachusetts | Office $55.25 | Facility $34.14 |
| Rest Of Michigan | Office $51.70 | Facility $33.40 |
| Rest Of Missouri | Office $50.09 | Facility $32.82 |
| Rest Of New Jersey | Office $57.39 | Facility $35.51 |
| Rest Of New York | Office $51.96 | Facility $32.92 |
| Rest Of Oregon | Office $53.17 | Facility $33.21 |
| Rest Of Pennsylvania | Office $51.52 | Facility $33.12 |
| Rest Of Texas | Office $52.27 | Facility $33.25 |
| Rest Of Washington | Office $55.11 | Facility $34.01 |
| Rhode Island | Office $54.95 | Facility $34.25 |
| Riverside-San Bernardino-Ontario | Office $56.53 | Facility $34.56 |
| Sacramento-Roseville-Folsom | Office $58.23 | Facility $34.92 |
| Salinas | Office $57.99 | Facility $34.77 |
| San Diego-Chula Vista-Carlsbad | Office $58.95 | Facility $34.99 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $66.13 | Facility $37.88 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $66.08 | Facility $37.82 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $67.49 | Facility $38.59 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $67.26 | Facility $38.36 |
| San Luis Obispo-Paso Robles | Office $57.11 | Facility $34.28 |
| Santa Cruz-Watsonville | Office $59.21 | Facility $34.86 |
| Santa Maria-Santa Barbara | Office $58.10 | Facility $34.73 |
| Santa Rosa-Petaluma | Office $59.79 | Facility $35.18 |
| Seattle (King Cnty) | Office $60.75 | Facility $36.16 |
| South Carolina | Office $51.52 | Facility $33.00 |
| South Dakota** | Office $52.67 | Facility $32.63 |
| Southern Maine | Office $52.92 | Facility $33.06 |
| Stockton | Office $55.97 | Facility $34.01 |
| Suburban Chicago | Office $55.96 | Facility $35.38 |
| Tennessee | Office $50.60 | Facility $32.38 |
| Utah | Office $52.02 | Facility $33.18 |
| Vallejo | Office $62.88 | Facility $36.47 |
| Vermont | Office $52.69 | Facility $32.85 |
| Virgin Islands | Office $54.04 | Facility $33.78 |
| Virginia | Office $52.84 | Facility $33.14 |
| Visalia | Office $55.97 | Facility $34.01 |
| West Virginia | Office $51.04 | Facility $33.62 |
| Wisconsin | Office $51.51 | Facility $32.31 |
| Wyoming** | Office $53.34 | Facility $33.30 |
| Yuba City | Office $55.97 | Facility $34.01 |
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G0557 billing questions
How does G0557 differ from G0556?
G0557 is the level for a patient with two or more qualifying chronic conditions. G0556 is the lower level for a patient with one qualifying chronic condition.
When would G0558 be more appropriate?
G0558 is the higher level for a patient with two or more qualifying chronic conditions who also meets the additional eligibility criterion for that level, including Qualified Medicare Beneficiary status.
Is G0557 reported according to staff time?
No. It represents a monthly advanced primary care management service, not a service selected by adding up a set number of staff minutes.
What documentation supports G0557?
Document the patient’s qualifying chronic conditions and the care-management services furnished, such as coordination with other clinicians, care-plan maintenance, or communication addressing ongoing care needs.
How is G0557 different from chronic care management code 99490?
G0557 reports the advanced primary care management model and is not selected using a monthly time threshold. Code 99490 describes time-based chronic care management, so the service model and documentation basis differ.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,349G0554,,Add 20 m of monthly tx,A,,0.61,0.60,,0.12,,0.03,1.24,0.76,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,350G0555,,Replacment pt electronic sys,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,3,XXX,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
15,351G0556,,Adv prim care mgmt lvl 1,A,,0.25,0.22,,0.06,,0.02,0.49,0.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,352G0557,,Adv prim care mgmt lvl 2,A,,0.77,0.79,,0.19,,0.05,1.61,1.01,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,353G0558,,Adv prim care mgmt lvl 3,A,,1.67,1.72,,0.39,,0.12,3.51,2.18,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,354G0559,,Unrelat prac follow up visit,A,,0.16,0.10,,0.05,,0.03,0.29,0.24,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,355G0560,,Safety plan interven,A,,1.09,0.17,,0.08,,0.01,1.27,1.18,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00