ACCESS co-management G-codes carry a $30 allowed amount, and claims deny without a track diagnosis

On October 29, 2026, CMS's MLN Connects newsletter asked clinicians to refer patients with chronic conditions to the ACCESS Model and pointed them to the Co-Management Payment billing guidance, last updated October 22. Three days earlier, on October 26, CMS signed a statutory waiver that lets Medicare Part B-enrolled pharmacies bill the payment, effective October 1, 2026.

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year CMS Innovation Center model that began July 5, 2026. Participating organizations provide technology-supported chronic care to people with Original Medicare. The part that reaches a coder's desk is the Co-Management Payment, or CMP: a small Medicare payment that the patient's other clinicians can bill when they review an ACCESS care update and act on it. CMS says no ACCESS enrollment is required for primary care providers or referring clinicians to bill it.

What the ACCESS Co-Management Payment pays for

CMS says the CMP pays eligible practitioners for reviewing ACCESS care updates and doing the care coordination that follows. ACCESS organizations must send those updates at care initiation, at escalation if clinical needs change, and at care completion.

To bill a CMP, the practitioner must review an ACCESS care update for that beneficiary and track and perform at least one care-coordination activity. CMS's examples include adjusting or reconciling medications, updating the problem list, setting or changing monitoring or follow-up instructions, coordinating with other clinicians, communicating with the ACCESS provider, and documenting agreement or disagreement with the ACCESS recommendations, with the rationale. The review and the coordination together need at least 5 minutes of practitioner time.

CMS also says documentation of the review is required to support each CMP claim, and that billing the CMP doesn't replace or affect billing for office visits or other distinct services.

G0676, G0677 and G0678: the CMP codes and amounts

Each ACCESS track has its own G-code. CMS lists the same allowed amount for all three.

CMS pays 100 percent of the allowed amount, subject to the 2 percent sequestration reduction, and actual payments vary by location under the Physician Fee Schedule geographic adjustment factor. Beneficiary cost-sharing doesn't apply, so CMS says practitioners don't need to get the beneficiary's consent in advance.

The diagnosis code decides whether the CMP claim pays

This is the line coders should notice. CMS's guidance says at least one diagnosis code on the claim must correspond to a qualifying condition for the ACCESS track being billed, as listed in the Value Sets section of the ACCESS Model API Implementation Guide. Claims without a corresponding diagnosis code will be denied.

The guide publishes a separate ICD-10-CM value set for each track. It's labeled a draft (version 0.9.12 when we checked), so pull the current list before you rely on it. A few examples from those lists:

Specificity matters here. The CKM track covers chronic kidney disease stage 3a and 3b, and the CKM value set we checked includes N18.30, N18.31 and N18.32 but not N18.4 (stage 4). Code what the record supports, then check it against the list for the track you're billing. Don't pick a diagnosis to fit the list.

Who can bill the CMP, and since when

The pharmacy waiver applies only to billing the CMP under ACCESS. It says it doesn't expand any practitioner's scope of practice, and it doesn't change anyone's obligations under the federal anti-kickback statute or other fraud and abuse laws.

CMP services can be furnished by auxiliary personnel under general supervision if they're employees, leased employees or contractors of the billing provider. In that case, the supervising practitioner's NPI goes in both Item 24J and Item 17. Pharmacies billing under specialty A5 leave Item 24J blank.

Frequency limits and professional claim details

The CMP is payable up to 3 times every 12 months, per beneficiary, per ACCESS track. A clinician can bill CMPs for more than one track for the same beneficiary when the review and care coordination are distinct for each track. CMS doesn't cap how many clinicians on a care team can bill the CMP for the same beneficiary, but it says it will monitor billing patterns for duplication or abuse.

On the 837P or CMS-1500, CMS asks for:

• The track's G-code in Item 24D, with the AC modifier when it applies
• One unit per claim line
• A date of service that matches the day the documented review or care coordination happened, filed within standard timely filing limits
• A place of service that reflects the rendering practitioner's setting
• The billing provider's Type 2 NPI in Item 33A, associated in PECOS with the TIN in Item 25

How FQHCs and RHCs report the CMP on institutional claims

FQHCs and RHCs bill the CMP on the 837I or CMS-1450 for dates of service on or after October 1, 2026. The type of bill is 71X for RHCs and 77X for FQHCs, and the G-code goes in FL 44.

If the underlying activity happened during a synchronous telehealth encounter, CMS says to use revenue code 0780 with modifier 95 for real-time audio and video, or modifier 93 for audio-only. Otherwise, use the clinic revenue code for your facility type. For the principal diagnosis in FL 67, CMS asks for the beneficiary's track-specific diagnosis at the highest level of specificity available, and says claims without a valid principal diagnosis code corresponding to the billed track will be denied.

New ACCESS tracks start April 1, 2027

CMS says ACCESS will add tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder and tobacco cessation starting April 1, 2027, along with a follow-on track for chronic musculoskeletal pain. CMS hasn't posted CMP codes or value sets for those tracks on the pages we checked, so watch the ACCESS pages before you bill for them.