$50.70
Use G0557 when the patient has two or more qualifying chronic conditions; G0556 is the one-condition level.
On this page
CMS RVU26D · Effective 2026-10-01
G0556 Primary care management Medicare reimbursement rates in Kentucky
Monthly advanced primary care management for a patient with one qualifying chronic condition requiring ongoing, coordinated primary care and support. Compare G0556 office and facility rates across CMS payment localities in Kentucky.
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 G0556 in Kentucky?
Kentucky 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
$15.49
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$10.74
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Care management
About G0556: Advanced primary care management, one condition
Monthly advanced primary care management for a patient with one qualifying chronic condition requiring ongoing, coordinated primary care and support.
G0556 represents a month of advanced primary care management for a patient with one qualifying chronic condition. The condition must be expected to last at least 12 months or until the patient’s death and place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. Common primary care populations include patients managing conditions such as diabetes, heart failure, or COPD, when the condition meets those criteria. A physician or other eligible primary care practitioner coordinates ongoing care, communication, and access across the patient’s care team.
Select this level based on the patient’s qualifying condition count, not the number of diagnoses mentioned in a visit. Report the service by month and document the qualifying condition, its expected duration and risk, and the care-management work provided, such as coordination, care planning, or support across care transitions. G0556 is the one-condition level; patients meeting the criteria for a higher condition-count level may fit G0557 or G0558 instead.
Where the value comes from
- Work RVU0.25 · 51%
- Practice expense (office) RVU0.22 · 45%
- Malpractice RVU0.02 · 4%
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.
G0556 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$110.52
G0558 is for patients with two or more qualifying chronic conditions who are Qualified Medicare Beneficiaries. G0556 is the one-condition level.
$62.56
99490 is time-based chronic care management involving clinical-staff time. G0556 is an APCM level selected by qualifying condition count.
Compare G0556 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
Kentucky →
Office / nonfacility
$15.49
Facility
$10.74
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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 G0556 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
15,351
- Code
- G0556
- Physician work
- 0.25
- Practice expense
- 0.22
- Malpractice
- 0.02
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.25 | × 1.000 | 0.2500 |
| Practice expense | 0.22 | × 0.889 | 0.1956 |
| Malpractice | 0.02 | × 0.915 | 0.0183 |
| Total RVUs | 0.4639 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$15.49
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.25 | 1 |
| Practice expense | 0.22 | 0.889 |
| Malpractice | 0.02 | 0.915 |
(0.25 × 1 + 0.22 × 0.889 + 0.02 × 0.915) × $33.4009 = $15.49
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.25 | 1 |
| Practice expense | 0.06 | 0.889 |
| Malpractice | 0.02 | 0.915 |
(0.25 × 1 + 0.06 × 0.889 + 0.02 × 0.915) × $33.4009 = $10.74
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.
G0556 billing questions
How does G0556 differ from G0557?
G0556 is the level for one qualifying chronic condition. G0557 is for patients with two or more qualifying chronic conditions.
What makes a chronic condition qualify?
The condition must be expected to last at least 12 months or until death and place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
Is G0556 reported per visit or per month?
It represents advanced primary care management for a month, not a single office visit. Document the ongoing management provided during the month.
Can G0556 be reported for a patient with several diagnoses?
The level is selected by the number of qualifying chronic conditions, not the total diagnosis count. If two or more conditions meet the criteria, assess whether G0557 or G0558 is the appropriate level.
How does G0556 differ from 99490?
G0556 is an advanced primary care management level selected by qualifying condition count. 99490 is a time-based chronic care management service with clinical-staff time requirements.
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.
15,348G0553,,Monthly tx for dmht 20mins,A,,0.62,0.97,,0.13,,0.03,1.62,0.78,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,349G0554,,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
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631