Maximizing Reimbursement for Remote Care with HCPCS Code G0511
- ChronicCare
- Mar 16
- 2 min read
Remote care services are reimbursed through various codes provided by CMS and private insurers. While most codes are specific to a particular type of remote care, HCPCS Code G0511 stands out as a versatile billing option for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). This unique code allows these organizations to bill for a range of remote care programs under a single reimbursement structure.
What Services Does G0511 Cover?
As of January 2024, FQHCs and RHCs can now use G0511 to bill for a wider range of remote care services, including:
Remote Patient Monitoring (RPM)
Remote Therapeutic Monitoring (RTM)
Chronic Care Management (CCM)
Principal Care Management (PCM)
These services play a crucial role in managing chronic diseases, such as:
✔ Hypertension (High Blood Pressure)
✔ Heart Failure (CHF)
✔ Chronic Kidney Disease (CKD)
✔ Chronic Obstructive Pulmonary Disease (COPD)
✔ Obesity
✔ Diabetes
With many patients managing multiple chronic conditions, FQHCs and RHCs have a unique opportunity to improve patient outcomes through comprehensive remote care programs. The inclusion of G0511 for RPM and CCM in CMS’s 2024 Physician Fee Schedule (PFS) expands access to critical services for underserved populations.
Billing RPM Under the 2024 Physician Fee Schedule (PFS)
FQHCs and RHCs can bill G0511 multiple times within a single month—as long as the coding requirements for each service are met without duplication. This flexibility ensures that these healthcare organizations can maximize reimbursement while delivering comprehensive patient care.
Expanding Chronic Care Management with G0511
G0511 is structured to keep costs manageable while expanding access to care. It includes reimbursement for three key CPT codes:
99490 – Chronic Care Management (CCM)
99487 – Complex CCM
99484 – Behavioral Health Integration (BHI)
The 2024 PFS Final Rule has further expanded G0511 to cover new programs such as CHI (Community Health Integration) and PIN (Principal Illness Navigation) in addition to existing CCM, PCM, RPM, and RTM services.
Can RHCs Bill Multiple Care Programs Under G0511?
Yes! Medicare now allows RHCs to bill for multiple instances of care management services under G0511, provided that each service’s resource costs are separately accounted for. While there is no specified maximum number of times the code can be billed in a single month, each service must meet its respective documentation and delivery requirements.
How ChronicCare Can Help
At ChronicCare, we specialize in helping FQHCs and RHCs streamline remote care services while maximizing reimbursement opportunities under G0511. Our pharmacist-led CCM and RPM programs enable healthcare organizations to provide comprehensive, patient-centered care while optimizing revenue.
Want to learn how your FQHC or RHC can leverage G0511 to improve patient outcomes and increase financial sustainability? Contact ChronicCare today!
Comments