Last updated: Jan 23, 2024
This is the fourth in our series on remote patient monitoring billing codes, focusing on HCPCS code G0511. Check out Part 1, which covers CPT® Codes 99453 and 99454; Part 2, which defines CPT® codes 99457, 99458, and 99091; and Part 3, which addresses some of the most frequently asked questions regarding the remote monitoring CPT® codes.
In the world of remote care, many codes exist for reimbursements for these services through CMS and commercial insurers. Most are specific to the type of remote care, but G0511 is a unique code. It only applies to specific care organization types and spans different remote care programs. Here’s everything you need to know about it.
What is HCPCS code G0511?
HCPCS code G0511 applies to specific healthcare organizations—federally qualified health centers (FQHCs) and rural health clinics (RHCs). Its official description is billing for “general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner.”
What services can you bill G0511 for?
As of January 1, 2024, FQHCs and RHCs can bill remote physiologic monitoring which includes remote patient monitoring (RPM), remote therapeutic monitoring (RTM), chronic care management (CCM), and principal care management (PCM). The CMS 2024 Physician Fee Schedule (PFS) made the critical inclusion of G0511 for RPM. Historically, FQHCs and RHCs have not been able to receive reimbursement for RPM services from CMS.
New PFS rule includes G0511 billing for RPM
The new rule states that FQHCs and RHCs can bill the code multiple times in a calendar month if they meet requirements for underlying services. There also cannot be any double counting. For instance, those providing TCM (transitional care management) services and complying with all the rules while meeting the RPM criteria can bill G0511 twice.
FQHCs and RHCs can provide all the services G0511 captures as long as they meet underlying requirements for each service and bill for all of them separately.
Requirements for billing G0511
- At least 20 minutes of care coordination services related to RPM, RTM, CCM, or PCM.
- The services must be under the direction of an FQHC or RHC billing provider
- The care can be under the general supervision of an FQHC or RHC provider, meaning you can outsource this to a remote care company that offers clinical monitoring services by licensed nurses.
For CCM, the patient must have at least two chronic conditions expected to last 12 months or more and puts the patient at significant health risk. Additionally, providers must establish, implement, revise, and monitor a comprehensive care management plan.
For RPM, patients must take 16 or more days of readings in a 30 day period or 20 minutes of clinical monitoring with a synchronous interaction.
More things to know about billing G0511
- Billing for RPM and RTM separately is now possible.
- You can bill code G0511 multiple times a month when you meet all requirements.
- The 2024 non-facility payment national average is $72.98.
- Tracking of time for each service is necessary for compliance.
What are common chronic conditions that benefit from remote care programs?
Remote care can encompass many chronic diseases that would be billable under G0511. Examples include:
- Heart disease
- Chronic kidney disease (CKD)
- Chronic obstructive pulmonary disease (COPD)
FQHCs see a significant share of patients with chronic conditions. The Centers for Disease Control and Prevention (CDC) revealed that 22.6% of nonmetropolitan residents have 2-3 chronic diseases, nearly 4% higher than metropolitan ones.
Nonmetropolitan populations also had higher rates of high cholesterol, high blood pressure, diabetes, and COPD. These groups also had higher disease death rates for heart disease, strokes, and respiratory diseases.
With the high levels of multi-chronic patients, FQHCs and RHCs can make significant progress by offering remote care programs. The addition of G0511 as applicable to RPM and CCM creates considerable opportunities for better patient outcomes.
Best practices for accurate and compliant billing of G0511
If you plan to launch an RPM program under G0511, here are some tips:
Use patient-friendly connected devices.
The medical devices you supply patients with must be easy to use. They’ll learn about them during onboarding and education. Cellular devices are the most efficient, as they don’t require the patient to use their smartphone or download an app like Bluetooth. Cellular devices have broader coverage and are ready to use out of the box. Choosing cellular ensures greater consistency in patient vital transmission, especially for patients living in nonmetropolitan areas.
Prioritize patient engagement for adherence.
With an RPM program, you’ll have a technology platform that enables direct communication between care teams and patients. They can receive automated reminders to take their readings daily. If patients forget to take readings, care teams can call or text them directly for additional reminders. This ecosystem ensures patients to actively participate in managing their health and make vital taking a habit.
Use a solution with automation features.
The right RPM platform automatically tracks activities by clinical staff. It counts all the time and interactions for eligible interactions automatically to bill for G0511.
Let RPM companies do the monitoring for you to decrease workload.
Each patient enrolled in RPM programs requires monitoring, as readings could become urgent moments for intervention. An escalation framework must be in place, and you can access this with external clinical monitoring services carried out by licensed U.S.-based nurses. When readings go beyond a threshold, they will immediately alert attending physicians.
FQHCs and RHCs can improve outcomes when partnering with Optimize Health
The new application of G0511 to RPM enables FQHCs and RHCs to expand remote care. By monitoring your most at-risk patients, you have the opportunity to gather data about their diseases and drive better clinical results.
Building a program requires technology, services, and guidance. We can help with customized RPM and CCM programs for FQHCs and RHCs. Learn more with these resources:
Want to learn more? Request a consultation with our team.
The Optimize Health 4-part remote patient monitoring billing code series:
- Part 1: CPT® Codes 99453 and 99454: What Healthcare Providers Should Consider
- Part 2: CPT® Codes 99457, 99458, and 99091: What Healthcare Providers Should Consider
- Part 3: Remote Monitoring CPT® Codes Frequently Asked Questions
- Part 4 (current): HCPCS Code G0511: What FQHCs and RHCs Should Consider
This content is for informational purposes only. Any information in this blog or the additional links is not legal advice to any individual or entity and is not in the context of an attorney-client relationship. Further, readers should not construe anything in this blog as a reimbursement guarantee.
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