CPT G0511 – Chronic Care Management for FQHCs

(Last Updated On: March 1, 2019)

Beginning January 1, 2018, FQHCs will be required to bill CPT G0511 for services previously billed as CPT 99490 or 994987. The key features of the new code are the following:

  • Includes monthly Chronic Care Management
  • Includes Complex Chronic Care Management
  • Includes Behavioral Health Integration provided by Primary Care Physicians
  • Can be billed with other services furnished during FQHC visit
  • A 50% reimbursement increase over 99490
  • Bolsters continuity of care

Requirements for eligibility and participation have not changed.

Resources

CMS, “Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Frequently Asked Questions,” November 2017. [Online: 11/30/2017]. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf