2024 Reimbursement Breakthrough: FQHCs and RHCs Chart a New Course with G0511
As of January 2024, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) can now bill for Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and other core preventative services. The news comes thanks to the Centers for Medicare and Medicaid Services (CMS) final rule released on November 2, 2023. This marks a significant development as it allows FQHCs and RHCs to receive payment for RPM and RTM services outside of the previously established RHC all-inclusive rates and the FQHC per visit payments.
The specific details of this change include the introduction of the general management code HCPCS G0511, through which FQHCs and RHCs can bill for services like Remote Patient Monitoring (RPM), Chronic Care management (CCM), Remote Therapeutic Monitoring and Principal Care Management (PCM). This expansion aims to accommodate the unique components of RPM, CCM, RTM, and PCM, acknowledging the additional resources required to provide these services.
Despite a reduction in the reimbursement amount for code G0511 from $77.94 in 2023 to $72.98 in 2024, CMS clarified that G0511 can be billed multiple times for the same patient in a month for all subcategory codes. This addresses concerns raised during the proposed rule period about the adequacy of using G0511 for distinct services like Chronic Care Management and Remote Patient Monitoring.
CMS Clarifications on Billing G0511 Multiple Times Per Month
An essential clarification from CMS is that G0511 can be billed for the same patient more than once per month, provided that all the requirements for each service are met. For example, if a patient is enrolled in both Chronic Care Management and Remote Patient Monitoring programs, FQHCs and RHCs can bill Medicare for each service in a given month.
This development is especially beneficial for FQHC and RHC Medicare beneficiaries, with expectations that many Medicaid plans will also adopt similar policies. Providers are encouraged to review their state Medicaid policies on the Center for Connected Health Policy website for additional information.
Furthermore, the final rule addresses suggestions from commenters regarding ways to clarify billing for separate subcategories under G0511. CMS stated its commitment to considering operational suggestions in future rulemaking and emphasized ongoing monitoring of utilization rates for these codes, with a willingness to adjust reimbursement rates as needed.
What’s Next For FQHCs
For FQHCs and RHCs seeking information on navigating these changes, the team at Mozzaz is ready to address any questions regarding G0511 and how our digital health platform can support Chronic Care Management, Remote Patient Monitoring, Remote Therapeutic Monitoring and other virtual care initiatives. We have been supporting FQHCs with RPM prior to the ability to reimburse through G0511 and are excited to see how these changes promote continued program sustainability.