$16.79
G0556 is the Level 1 APCM code for patients with one or more chronic conditions. G0558 is for patients with at least two chronic conditions who also qualify as QMBs.
On this page
CMS RVU26D · Effective 2026-10-01
G0558 Advanced care management Medicare reimbursement rates in Colorado
Monthly advanced primary care management for a patient with at least two chronic conditions who also qualifies as a Qualified Medicare Beneficiary. Compare G0558 office and facility rates across CMS payment localities in Colorado.
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 G0558 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$120.71
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$73.44
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Primary care management
About G0558: Advanced primary care management, QMB patient
Monthly advanced primary care management for a patient with at least two chronic conditions who also qualifies as a Qualified Medicare Beneficiary.
G0558 represents a month of advanced primary care management for a patient with at least two chronic conditions who is also a Qualified Medicare Beneficiary (QMB). A primary care physician or other eligible primary care practitioner furnishes ongoing, coordinated care rather than a single office visit or isolated phone call. The service includes practice capabilities such as continuous access to care, a patient-centered care plan, comprehensive management, and coordination during care transitions.
Select this level based on the patient’s documented chronic conditions and QMB status, not the number of contacts or minutes spent. Record the patient’s consent and the APCM services and care-plan work furnished during the month. CMS assigns physician fee schedule relative values with separate office and facility practice-expense inputs. The code represents monthly APCM care-management work, not a separate unit for each call or care-planning task.
Where the value comes from
- Work RVU1.67 · 48%
- Practice expense (office) RVU1.72 · 49%
- Malpractice RVU0.12 · 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.
G0558 compared with similar codes
Office rates for Colorado, from the same CMS release.
$55.41
G0557 covers Level 2 APCM for patients with at least two chronic conditions. QMB status distinguishes the Level 3 population reported with G0558.
$67.97
99490 describes chronic care management under its own service requirements. G0558 represents the APCM model and requires the Level 3 chronic-condition and QMB criteria.
Compare G0558 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
$120.71
Facility
$73.44
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0558 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
15,353
- Code
- G0558
- Physician work
- 1.67
- Practice expense
- 1.72
- Malpractice
- 0.12
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.67 | × 1.012 | 1.6900 |
| Practice expense | 1.72 | × 1.064 | 1.8301 |
| Malpractice | 0.12 | × 0.781 | 0.0937 |
| Total RVUs | 3.6138 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$120.71
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.67 | 1.012 |
| Practice expense | 1.72 | 1.064 |
| Malpractice | 0.12 | 0.781 |
(1.67 × 1.012 + 1.72 × 1.064 + 0.12 × 0.781) × $33.4009 = $120.71
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.67 | 1.012 |
| Practice expense | 0.39 | 1.064 |
| Malpractice | 0.12 | 0.781 |
(1.67 × 1.012 + 0.39 × 1.064 + 0.12 × 0.781) × $33.4009 = $73.44
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
G0558 billing questions
What qualifies a patient for G0558 rather than G0557?
Both levels are for patients with at least two chronic conditions. G0558 is the level for a patient who also has Qualified Medicare Beneficiary status.
Is G0558 reported per call or per 20 minutes?
No. G0558 represents a monthly APCM service, rather than a unit for each contact or a timed increment.
What should the record support?
Document at least two chronic conditions, the patient’s QMB status and consent, and the advanced primary care management furnished, including relevant care planning and coordination.
Does G0558 describe an office visit?
No. It represents the monthly APCM care-management service. It is distinct from documenting a separately furnished evaluation and management visit.
Can a modifier make a patient eligible for G0558?
No. The Level 3 selection depends on the patient meeting the chronic-condition and QMB criteria; a modifier cannot replace that support.
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.
15,350G0555,,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
15,356G0561,,"Temp tube delivery, unil",C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899