In 2018, CMS introduced code G0511 for general care management specifically for RHCs and FQHCs. The HCPCS code originally enabled these facilities to bill under the umbrella of CPT codes 99490 (20 minutes or more of CCM services), 99487 (60 minutes or more of complex CCM services), and 99484 (20 minutes or more of general behavioral health integration services).
The official CMS description for G0511 is “general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner.”1
In the 2024 PFS Final Rule, G0511 has been updated to include the new CHI and PIN programs along with CCM, PCM, RPM, and RTM. The Final Rule states FQHCs and RHCs can bill the code multiple times in a calendar month if requirements are met for the underlying services.
Rather than diluting reimbursement by dividing evenly amongst all the CCM codes, a weighted average based on utilization from the CY 2021 is used. Although reimbursement decreases by a small amount, the use of new codes including RPM, CHI, and PIN allow for multiple codes to be billed concurrently, making this a positive change overall.
CMS payment language states “We pay CCM services at the weighted average of the non-facility PFS payment rates for the base code and add-on code pairs, in addition to the individual base codes for all of the services that comprise HCPCS code G0511 by using the most recent PFS utilization data.”2
From January 1st-March 8th 2024 the payment rate for G0511 was $71.71. However, the partial funding patch passed by Congress included a 1.68% reduction to the 3.37% cut in the 2024 CMS PFS conversion factor. The payment rate for G0511 from March 9th through the remainder of 2024 is $72.90.
