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CPT code G0511 for rural health clinics and federally qualified health centers

Care management services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) include the following 4 services: transitional care management, chronic care management, general behavioral health integration and a psychiatric collaborative care model. This article will focus on the CCM part of the services and its relevant CPT codes.

What are the CCM code available to RHCs and FQHCs?
CCM services provided by RHCs and FQHCs between January 2016 and December 2017, can be billed for by adding CPT code 99490 to an RHC or FQHC claim, either alone or with other payable services.
In 2018, Rural Health Clinics and FQHCs received a new code for CCM, CPT code G0511, which pays an average of 3 codes 99490, 99484 and 99487. In 2019, the code G0511 calculation was updated by recognizing the new higher paying code 99491. And although the Rural Health Clinics and FQHCs cannot bill for 99491 (or 99490 beyond December 2017), the 99491 CPT code replaced the 99490 code in the calculation of the average payment amount. As a result, as of January 2019, the G0511 reimbursement increased to $67.

Can RHCs and FQHCs bill for CPT code 99487?
Unlike general healthcare practices, RHCs and FQHCs are not eligible to utilize code 99487 that pertains to complex CCM services. RHCs and FQHCs can use G0511 only when it comes to Chronic Care Management services.

Can care management costs such as software or management oversight be included on the cost report?
Yes. Any cost incurred as a result of the provision of RHC and FQHC services, including care management, is a reportable cost and must be included in the Medicare cost report. Direct costs for care management services are reported in the “Other than RHC/FQHC Services” section of the cost report and are not used in determining the RHC AIR or the FQHC PPS rate.

Can RHCs and FQHCs bill for more than one care management service in the same month for an individual?
No. RHCs and FQHCs can only bill one care management service for an individual per month, meaning it is not possible to bill for CCM and psychiatric services in the same month.

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Centers for Medicare & Medicaid Services


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