CPT Code G0511 For FQHCs & RHCs

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CPT Code G0511

Ever since the year 2022, healthcare providers at Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) provide remote monitoring for certain care management services with a limit on the time spent on/ with patients for reimbursements.

In remote care, there are various codes used to get paid for these services, both from CMS and private insurers. While most of these codes are specific to the type of remote care being provided, there’s one special code called G0511. This code is unique because it’s only used by certain types of healthcare organizations and covers different remote care programs.

HCPCS code G0511 is specifically for healthcare organizations like FQHCs and RHCs. Its official description involves billing for “primary care management,” which includes at least 20 minutes of clinical staff time dedicated to Chronic Care Management (CCM), Principal Care Management (PCM) services or Behavioral Health Integration (BHI) services, under the direction of a practitioner at an RHC or FQHC.

What Services Does G0511 Cover?

Starting from January 1, 2024, FQHCs and RHCs can use G0511 to bill for certain remote monitoring services. These services include Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Chronic Care Management (CCM), and Principal Care Management (PCM).

In the 2024 Physician Fee Schedule (PFS) by CMS, they made sure to add G0511 for RPM. This is a significant development because, before this, FQHCs and RHCs couldn’t get reimbursed by CMS for providing RPM services.

Physicians Fee Schedule (PFS) Rule For Billing RPM

Now, with the latest rule in place, federally qualified health centers (FQHCs) and rural health clinics (RHCs) have the green light to use the G0511 code more than once within a single month, given they fulfill the prerequisites for each service without any overlap.

For example, if they are already offering Transitional Care Management (TCM) services and adhere to all the regulations while also meeting the RPM criteria, they can bill G0511 twice.

This means that FQHCs and RHCs can deliver all the services covered by G0511, ensuring they meet the specific requirements for each service and bill for them separately.

How To Bill G0511?

To bill for G0511, you need to offer at least 20 minutes of care coordination services linked to Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Chronic Care Management (CCM), or Principal Care Management (PCM).

These services must be overseen by a billing provider from a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). Additionally, the care can be supervised generally by an FQHC or RHC provider. This means you can enlist the help of a remote care company that provides remote monitoring services conducted by licensed nurses or healthcare providers.

CCM Requirements For Billing

To qualify for Chronic Care Management (CCM), the patient needs to have at least two long-term health conditions that are expected to last for a year or more. These conditions should also pose a significant risk to the patient’s health.

Moreover, healthcare providers must create, put into action, update, and keep an eye on a thorough care management plan for the patient.

RPM Requirements for Billing

To qualify for Remote Patient Monitoring (RPM), patients need to either:

  • Take readings on 16 or more days within 30 days, or
  • Have a remote monitoring session lasting 20 minutes, which includes a live interaction like an audio/ video call, etc. with a healthcare provider.

Now you can bill separately for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM). You’re also allowed to use code G0511 more than once a month if you meet all the rules. As for payment, in 2024, the average payment is $72.98 for each service (varies across locations).

RTM Requirements for Billing

For reimbursement coverage, RTM services must be medically reasonable and meet all the coding requirements for an episode of care given in a calendar month.

  • At least 20 minutes of care coordination services related to RTM.
  • This care can be under the general supervision of an FQHC or RHC provider

Both RHCs and FQHCs may bill HCPCS code G0511 multiple times in a calendar month.

Which Conditions Are Billable Under G0511?

Remote care services covered by G0511 can address various chronic diseases, such as:

  • High blood pressure (Hypertension)
  • Heart failure (CHF)
  • Chronic kidney disease (CKD)
  • Chronic obstructive pulmonary disease (COPD)
  • Obesity
  • Diabetes

With many patients having multiple chronic conditions, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can make a big difference by offering remote care programs. The inclusion of G0511 for Remote Physiologic Monitoring (RPM) and Chronic Care Management (CCM) opens up significant opportunities for improving patient outcomes.

Best Billing Practices For G0511

  • Use Cellular Connected Devices 

The medical devices you give to patients should be simple to handle. Cellular devices are easy to use and manage and do not require connecting to a Wi-Fi.

  • Prioritize Patient Engagement For Adherence

Using an RPM program means you get a tech platform that lets your healthcare team talk directly with you. You’ll get automatic reminders to take your readings every day. If you forget, your team can call or text you for more reminders. This system helps you stay involved in managing your health and makes taking vitals a regular habit.

HealthArc’s Digital Platforms Assist With Efficient Billing

With G0511 applying to RPM, FQHCs and RHCs can do more with remote care. By keeping a close watch on your riskiest patients, you can gather important data about their conditions and help them get better care.

HealthArc is your reliable partner in enhancing patient outcomes and engagement using digital health platforms and software designed to scale your healthcare results.

Please request a free demo to learn about FQHCs and RHCs billing codes. Also, feel free to talk to our team at +201 885 5571 for any queries about the CPT Code G0511.