HCPCS G0557

Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology

Current code27 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS G0557 by hospital
HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$71.69 – $1947 plans——
Deaconess Medical CenterSpokaneFile dated 2026-08-27$68.99 – $1338 plans——
Harborview Medical CenterSeattleFile dated 2026-04-01$69.42 – $92.363 plans——
Island HospitalAnacortes$57.97 – $80.505 plans——
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01$83.51 – $1234 plans$16.90 – $48.10Doctor’s fee: $31.20 – $48.10$26.00 – $74.00Doctor’s fee: $48.00 – $74.00
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$105 – $2345 plans——
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$71.89 – $1808 plans——
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$71.89 – $1808 plans——
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$72.25 – $1808 plans——
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$68.99 – $1338 plans——
Olympic Medical CenterPort AngelesFile dated 2026-06-24———
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$47.86 – $1147 plans——
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$70.56 – $1399 plans——
Providence Centralia HospitalCentraliaFile dated 2026-04-01$73.33 – $2296 plans——
Providence Holy Family HospitalSpokaneFile dated 2026-04-01$50.10 – $1539 plans——
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$51.20 – $1328 plans——
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01$27.70 – $1737 plans——
Providence St Peter HospitalOlympiaFile dated 2026-04-01$36.63 – $16810 plans——
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$64.00 – $1549 plans——
Swedish IssaquahIssaquahFile dated 2026-04-01$65.26 – $18510 plans——
Swedish Medical CenterSeattleFile dated 2026-04-01$65.08 – $18418 plans——
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$65.08 – $18412 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$72.25 – $1808 plans——
University of Washington Medical CtrSeattleFile dated 2026-04-01$69.42 – $13611 plans——
Virginia Mason Medical CenterSeattle$96.72 – $1103 plans——
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27$1101 plan——
Yakima Valley MemorialYakimaFile dated 2026-08-27$70.12 – $95.876 plans——

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County)
$60.75 in an office; $36.16 in a hospital or surgery center
Doctor's fee, rest of Washington
$55.11 in an office; $34.01 in a hospital or surgery center
Hospital outpatient payment (national)
$38.28 (APC 5821)

How hospitals also write this code

Some price files write it differently. These are counted as HCPCS G0557:

  • G0557P (with a letter after it, P; 2 price lines)
  • G0557T (with a letter after it, T; 1 price line)