New HCPCS Code G0511 for FQHCs | Chronic Care Billing

By Prateek Haswani | July 6, 2024

Remote care services are reimbursed for using a variety of codes, both from CMS and private insurers. While most of these codes are particular to the type of remote care being offered to patients, there is one unique code – G0511, used by Federally Qualified Health Centres (FQHCs) and covers a variety of remote care programs.

HCPCS code G0511 is formulated specifically for healthcare organizations such as FQHCs and RHCs (Rural Health Centers). Its official description includes 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), or Behavioral Health Integration (BHI) services, as directed by a practitioner at the FQHC.

Table of Contents

What Services Does G0511 Cover?

FQHCs are allowed to bill for certain remote monitoring services using G0511 from Jan 2024. These services include RPM (Remote Patient Monitoring), RTM (Remote Therapeutic Monitoring), CCM (Chronic Care Management), and Principal Care Management (PCM). CMS included G0511 for RPM in its 2024 Physician Fee Schedule (PFS).

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 Patient Monitoring (RPM) and Chronic Care Management (CCM) opens up significant opportunities for improving patient outcomes.

Physicians Fee Schedule (PFS) Rules for Billing RPM

Federally Qualified Health Centers (FQHCs) have the green light to use the G0511 code more than once within a single month, provided they complete the coding requirements for each service without any overlap.

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

Expanding Care at FQHCs With Code G0511

G0511, like other FQHC codes help keep expenses down. G0511 includes three CPT codes: 99490, 99487, and 99484. This means that reimbursement for both chronic care management and behavioral health integration at the same.

G0511 was revised in the 2024 PFS Final Rule to cover the new CHI and PIN programs, in addition to CCM, PCM, RPM, and RTM. According to the Final Rule, FQHCs and RHCs can bill the code more than once per calendar month if the underlying service standards are completed.

Can RHCs Bill Various Care Programs With G0511?

Yes. G0511 can now be billed for multiple instances of various care management services in a month if, according to Medicare, “the resource costs associated with each of the services are separately accounted for.”

However, the 2024 Final Rule does not specify a maximum number of times the code can be filled in a single month.

HealthArc’s Digital Platform Simplifies Care Management For FQHCs

With G0511 applying to multiple instances of remote care, FQHCs can do more with remote monitoring. By keeping a close watch on the riskiest patients, healthcare 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 platform and RPM software designed to scale your healthcare outcomes.

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

Frequently Asked Questions (FAQs)

1) What is HCPCS code G0511?

G0511 is a general care-management code for FQHCs and RHCs that captures 20 minutes or more of clinical staff time in a calendar month under practitioner direction for services such as CCM and BHI.

2) Which services can be billed under G0511 (historically and during 2024)?

In 2024, G0511 may be used to bill care-management services including CCM, PCM, BHI, and—per 2024 policy updates—RPM and RTM.

3) What changes in 2025 for FQHCs and RHCs?

Beginning January 1, 2025, G0511 is being unbundled. FQHCs/RHCs are directed to bill the individual CPT/HCPCS codes for each care-management service (for example, CCM, PCM, RPM, RTM, BHI).

4) Is there a grace period to continue using G0511 in 2025?

Yes. Facilities may continue billing with G0511 through September 30, 2025, while systems and workflows are updated. Once you switch to individual codes, use that approach consistently.

5) Can G0511 be billed more than once in the same month?

Yes—multiple billings in a month are allowed when each billed unit reflects distinct, non-overlapping time that fully meets requirements. Do not double-count minutes across services.

6) Who may provide the time count toward G0511?

Clinical staff or auxiliary personnel under the general supervision of the billing practitioner may furnish qualifying time. Maintain clear documentation of activities and minutes.

7) Does G0511 cover RPM and RTM time?

For 2024, yes. Starting in 2025, bill the specific RPM/RTM CPT codes (including add-ons when applicable) rather than G0511.

8) What about TCM—can it be billed alongside other care-management services?

Transitional Care Management can be billed in conjunction with other care-coordination services when all requirements are met. In 2025, TCM is billed under its own CPT codes (not via G0511).

9) What documentation should we keep for G0511?

Track time logs, care-plan elements, clinical staff activities, communications and escalations, and evidence of practitioner oversight. Align documentation to the service furnished (e.g., CCM vs. BHI).

10) Can we switch back and forth between G0511 and individual codes during 2025?

No. Use one method consistently during the transition window: either continue with G0511 through September 30, 2025, or move to the individual codes starting January 1, 2025.

11) How does G0511 differ from G0512?

G0512 is used for the psychiatric Collaborative Care Model (CoCM) and remains separately payable, with distinct time and service requirements from G0511.

12) Are there frequency limits on G0511?

G0511 may be billed multiple times per patient per month when each unit satisfies all service requirements without overlapping minutes. Please refer to your MAC’s instructions for any local nuances.

13) Do patients need to provide consent?

Yes. Patient consent is required for these non–face-to-face services. Consent may be obtained by auxiliary personnel under general supervision, consistent with program rules.

14) Does the 2025 change affect RHCs as well as FQHCs?

Yes. The transition to billing individual CPT/HCPCS codes applies to both RHCs and FQHCs, with the same option to continue using G0511 through September 30, 2025.

15) Which specific code families replace G0511 in 2025?

Facilities will use the applicable code families for care coordination and management (for example, CCM, PCM, APCM/CPM, General BHI, RPM, RTM, CHI, PIN, PIN-PS) and any related add-on codes, as appropriate.

16) What’s one common compliance pitfall to avoid?

Overlapping minutes—counting the same staff time toward two services—or changing billing methods mid-period. Keep separate, auditable time records and follow a single approach during the transition.

17) Can MAC guidance differ?

Yes. While national policy applies broadly, operational details can vary by MAC. Please ensure you check any regional instructions regarding edits, examples, or documentation preferences.

Tags: #ccm, #ccmcodes, #chroniccaremanagement