.jpg "Daniel Godla")
The 2025 Medicare Physician Fee Schedule includes a significant change for Rural Health Clinics, or RHCs, and Federally Qualified Health Centers, or FQHCs.
Starting January 1st of 2025, rural providers may bill for care management services using individual HCPCS/CPT codes and add-on codes rather than the single code G0511. This means that rural providers can provide multiple programs, accumulate time, bill for these services, and gain additional reimbursement. The Medicare care management programs that RHCs and FQHCs can begin billing for include:
- Advance Care Planning
- Advanced Primary Care Management
- Annual Wellness Visit
- Behavioral Health Integration
- Chronic Care Management
- Chronic Pain Management
- Community Health Integration
- Principal Care Management
- Principal Illness Navigation
- Remote Patient Monitoring
- Remote Therapeutic Monitoring
General Care Management Code G0511
Rural health providers can still bill the general care management code G0511.
CMS has established a six-month transition period for RHCs and FQHCs to stop using G0511 and switch to individual HCPCS/CPT codes. Organizations can continue to bill using G0511 until July 1, 2025. After that date, only the individual codes will be accepted. This transition period allows groups to update their billing systems in preparation for the change.
Keep in mind that you cannot bill G0511 for some patients and use individual codes for others during the grace transition period; it's one or the other.
In this video, we'll walk through this change and give you our recommendations to optimize billing your practice as well as review the updated reimbursement rate for G0511.
Download free guides to help you manage Medicare's care management programs.
