G0557 Primary care management Medicare reimbursement rates in Maine

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.