HCPCS G0558: Advanced care managementMedicare rate & RVUs in Nevada
Monthly advanced primary care management for a patient with at least two chronic conditions who also qualifies as a Qualified Medicare Beneficiary.
Medicare pays $116.63 for G0558 in the office in Nevada (Nevada**). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What G0558 covers
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.
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 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $116.63 | $72.16 |
How the G0558 rate is calculated
Each of G0558’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0558
RVUs × geographic indexes × conversion factor
Work1.67
1.67 RVUs× 1.000 GPCI
Practice expense1.72
1.72 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
3.5100
Conversion factor
$33.4009
Medicare rate
$117.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0558
G0558 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0558
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$117.24
- Non-facility (office)
- $117.24
- Facility
- $72.81
Higher because the practice carries its own overhead.
G0558 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- G0556Primary care management
- 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.
- G0557Primary care management
- G0557 covers Level 2 APCM for patients with at least two chronic conditions. QMB status distinguishes the Level 3 population reported with G0558.
- 99490Chronic care management
- 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.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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