Since Medicare introduced care management programs in 2015, coverage has evolved to provide expanded opportunities for Rural Health Clinics and Federally Qualified Health Centers. Historically, however, new care management programs have been launched without initially including RHCs and FQHCs or with significant restrictions.
There’s also a lack of clarity around what services RHCs and FQHCs can now bill under HCPCS code G0511 for General Care Management. In this article, we’ll highlight the programs that are covered, and offer recommendations for capturing maximum value.
Making sense of HCPCS code G0511
Coding for General Care Management is a bit like a pot of soup with multiple ingredients.
While other providers have numerous codes for billing various care management programs, rural health organizations have one HCPCS code, G0511, to cover all available programs.
The reimbursement rate set for this code ($71.68*) is an average of 28 separate CPT billing codes.
The G0511 "soup" covers eight care management programs, including:
Chronic Care Management
- 99490: 20 minutes of Chronic Care Management (Non-complex)
- 99439: 20 additional minutes of Chronic Care Management (Non-complex)
- 99487: 60 minutes of Chronic Care Management (Complex)
- 99489: 30 additional minutes of Chronic Care Management (Complex)
- 99491: 30 minutes of Chronic Care Management (Physician-delivered)
- 99437: 30 additional minutes of Chronic Care Management (Physician-delivered)
Principal Care Management
- 99424: 30 minutes of Principal Care Management (Physician-delivered)
- 99425: 30 additional minutes of Principal Care Management (Physician-delivered)
- 99426: 30 minutes of Principal Care Management (Clinician-delivered)
- 99427: 30 additional minutes of Principal Care Management (Clinician-delivered)
Behavioral Health Integration
- 99484: 20 minutes of Behavioral Health Integration
Chronic Pain Management
- G3002: 30 minutes of Chronic Pain Management
- G3003: 15 additional minutes of Chronic Pain Management
Remote Patient Monitoring
- 99454: Remote Patient Monitoring physiological data review with at least 16 days of readings
- 99457: 20 minutes of Remote Patient Monitoring clinical engagement
- 99458: 20 additional minutes of Remote Patient Monitoring clinical engagement
- 99474: Digitally stored data services
- 99091: Interpretation of Remote Patient Monitoring data plus 30 minutes of clinical time
Remote Therapeutic Monitoring
- 98976: Remote Therapeutic Monitoring physiological data review with at least 16 days of readings
- 98977: 20 minutes of Remote Therapeutic Monitoring
- 98980: 20 minutes of Remote Therapeutic Monitoring (Physician-delivered)
- 98981: 20 additional minutes of Remote Therapeutic Monitoring (Physician-delivered)
Principal Illness Navigation
- G0023: 60 minutes of Principal Illness Navigation
- G0024: 30 additional minutes of Principal Illness Navigation
- G0140: 60 minutes of peer support time
- G0146: 60 additional minutes of peer support time
Community Health Integration
- G0019: 60 minutes of Community Health Integration
- G0022: 30 additional minutes of Community Health Integration
Can RHCs offer multiple programs using G0511?
Yes. G0511 can now be billed for more than one instance in a month for different care management services if, according to Medicare, “the resource costs associated with each of the services are separately accounted for.”
That means one patient can have multiple “servings” of the General Care Management soup in a month.
However, the 2024 Final Rule does not appear to establish a maximum number of times the code may be filled in a given month. More clarification is needed from CMS if billing more than once per month per program is allowed.
We advise proceeding with billing multiple instances of a single program at your discretion.
G0511 allows for Remote Patient Monitoring
G0511 now includes Remote Patient Monitoring.
For each “minute-based” code successfully completed, an instance of G0511 can be billed.
Our recommendations for using G0511
Even with new programs such as Community Health Integration (CHI), Remote Therapeutic Monitoring (RTM), and Principal Illness Navigation (PIN) made available to rural providers in 2024, we suggest focusing on three well-established and trusted programs.
These include Chronic Care Management, Remote Patient Monitoring, and Behavioral Health Integration. If you use 20 minutes for each program each month, you can bill for multiple instances of G0511. There are also certain ways these programs can be combined to improve overall patient outcomes. For example:
- Offer Remote Patient Monitoring to all Chronic Care Management patients
- Offer Behavioral Health Integration to all Chronic Care Management patients
- Add Principal Care Management to Chronic Care Management for patients with a complex chronic condition
What could billing under the expanded G0511 look like?
Here is one example of what a month’s worth of G0511 time could look like:
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On the final day of the month, staff should bill for all instances of G0511 in one bill but keep documentation for activities carried out on each date for auditing purposes.
Total instances of G0511: 3
Total minutes: 60
Total billed at the end of the month: $215.04
Reminders and best practices for G0511 coding
The expansion of G0511 to include multiple instances in a month for different care management services requires a new approach to billing. Previously, G0511 could only be billed for one instance a month.
Many times, staff would bill for that single instance right after it occurred within the month. Now, with the ability to have multiple instances within one month, it’s essential not to bill until the end of the month since you can only bill once in a calendar month for G0511.
Accumulate instances across programs and bill for all instances at one time. Also, since you’re not breaking out each instance in the bill, ensure adequate documentation to show how minutes were used in alignment with program requirements.
ThoroughCare simplifies care management for RHCs
ThoroughCare offers a comprehensive software platform to streamline care management. Our tools automatically account for all of Medicare’s rules and requirements while documenting service records. Plus, ThoroughCare makes it easy to engage patients and maximize service time. Simply enroll patients to get started.
*Reimbursement rates can change throughout the year.
Check the Physician Fee Schedule for the latest information.