Overview - Care Management Updates:

On November 15, the final rule of the Medicare 2018 Physician Fee Schedule was published.  The updates include new billing codes and increased reimbursement for Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) when certain care management services are furnished. Beginning on January 1, 2018, two new billing codes present RHCs and FQHCs with the opportunity to receive higher reimbursement for providing Chronic Care Management (CCM), Behavioral Health Integration (BHI), and Psychiatric Collaborative Care Model (CoCM) services.

Two New Billing Codes:

Effective January 1, 2018, HCPCS codes G0511 (General Care Management) and G0512 (Psychiatric CoCM) will provide simplified billing and enhanced payment for Federally Qualified Health Centers and Rural Health Centers.

HCPCS code G0511 -  FQHCs and RHCs providing 20 minutes or more of CCM or general BHI services on or after January 1, 2018 can bill HCPCS code G0511 alone or with an RHC or FQHC claim. The new payment rate is based on the average of the national non-facility PFS payment rate for 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 BHI services).

• Reimbursement: $62.28

HCPCS code G0512 - FQHCs and RHCs may receive payment for providing 70 minutes or more of initial psychiatric CoCM services, or 60 minutes or more of subsequent psychiatric CoCM services by billing HCPCS code G0512, either alone or with an RHC or FQHC claim. The enhanced reimbursement rate is based on an average of the national non-facility PFS payment rate for CPT code 99492 and CPT code 99493.

• Reimbursement: $145.08

The updates to the 2018 Physician Fee Schedule include the addition of these two new codes for FQHCs and RHCs, as well as the replacement of the three original psychiatric CoCM codes G0502-G0504 with CPT codes 99492-99494 beginning on January 1, 2018. 

Summary:

Beginning on January 1, 2018 all chronic care and behavioral health management services provided by RHCs and FQHCs must be billed utilizing the new HCPCS codes. Claims submitted under CPT 99490 for CCM services provided on or before December 31, 2017, will be processed and paid.  However, claims submitted under CPT 99490 for services provided after this date will not be approved. 

Interested in learning more about the new billing code updates for Rural Health Centers and Federally Qualified Health Centers? Check out the FQHC fact sheet, RHC fact sheet and RHC/FQHC FAQs located on our CCM resources page.