HCPCS G0556: Primary care managementMedicare rate & RVUs in Oregon
Monthly advanced primary care management for a patient with one qualifying chronic condition requiring ongoing, coordinated primary care and support.
Medicare pays $16.14–$17.14 for G0556 in the office in Oregon, from Rest Of Oregon to Portland. 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 G0556 covers
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.
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.
Where G0556 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $17.14 | $11.21 |
| Rest Of Oregon | $16.14 | $10.82 |
How the G0556 rate is calculated
Each of G0556’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 · G0556
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.25Practice expense 0.22Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0556
G0556 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 · G0556
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$16.37
The facility rate would be $11.02 (+$5.35). In a facility, the facility bills its own costs separately.
G0556 compared with similar codes
Compare codes
G0556 vs G0557 vs G0558 vs 99490: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G0557Primary care management
- Use G0557 when the patient has two or more qualifying chronic conditions; G0556 is the one-condition level.
- G0558Advanced care management
- G0558 is for patients with two or more qualifying chronic conditions who are Qualified Medicare Beneficiaries. G0556 is the one-condition level.
- 99490Chronic care management
- 99490 is time-based chronic care management involving clinical-staff time. G0556 is an APCM level selected by qualifying condition count.
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 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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