New Code G0511 For FQHCs Expands Chronic Care Management

Chronic Care Management

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.

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.