New Care Management Services Billing Guidelines for Health Centers

AAFCPAs would like to make Federal Qualified Health Center (FQHC) clients aware that effective January 1, 2018, there are new billing guidelines for care management services.
Care management services include the following four services:

  • Transitional Care Management (TCM)
  • Chronic Care Management (CCM)
  • General Behavioral Health Integration (BHI)
  • Psychiatric Collaborative Care Model (CoCM)

FQHCs may be reimbursed for Chronic Care Management, Psychiatric Collaborative Care Model or Behavioral Health Integration services using G codes G0511 or G0512.  Billing changes are as follows:

  • CCM services of 20 minutes or more, furnished on or after January 1, 2018, may be billed by adding the G code of G0511 either alone or with other payable services. Please note: CCM services billed with CPT code 99490 for dates of service January 1, 2018 or after will be denied.
  • BHI services of 20 minutes or more, furnished on or after January 1, 2018, may be billed by adding the G code of G0511 either alone or with other payable services.
  • CoCM services of 70 minutes or more (initial) or 60 minutes or more (subsequent), furnished on or after January 1, 2018, may be billed by adding the G code of G0512 either alone or with other payable services.
  • There are no changes to the TCM billing guidelines.

The 2018 G code payment rates for care management services are:

  • G0511 $62.28
  • G0512 $145.08

Effective January 1, 2018, claims billed with CPT codes 99490, 99487, 99484 or 99493 will not be paid.  FQHCs and Rural Health Clinics (RHCs) should utilize G0511 or G0512.
Please reference the following Centers for Medicare and Medicaid Services (CMS) links for additional information.

Care Management Services Frequently Asked Questions

Federally Qualified Health Centers Spotlight

Rural Health Centers Spotlight

AAFCPAs can help facilitate these changes by providing:

  • 2018 revenue estimates
  • Advice on enterprise (or electronic) practice management (EPM) and electronic health record (EHR) system changes/updates
  • Guidance on minimizing denials
  • Assistance with staff training
  • Analysis of billing department staffing

AAFCPAs can also perform a complete billing analysis, including but not limited to:

  • Charge master examination
  • Financial/data reporting
  • Contract examination
  • Process improvements
  • Technology implementations
  • Denial trend analysis
  • Financial/cost analysis

AAFCPAs has spent over four decades providing incisive financial knowledge and strategic management advice to help our healthcare clients obtain optimal reimbursements, maintain regulatory compliance, increase cash flow and sustain performance. Our Healthcare Practice, and integrated Business Performance, Internal Controls & IT Advisory Practice provides best practice recommendations and operational process reviews surrounding third-party billing and collection, accounts receivable management, reserve analysis, fee schedule analysis, business process improvement, and recommendations for implementing denial management processes.
If you have questions please contact Matt Hutt, CPA, CGMA, at 774.512.4043,; or your AAFCPAs Partner.

About the Author

Matthew Hutt CPA
Matt leads AAFCPAs’ Healthcare Division, providing assurance, tax and advisory solutions for Federally Qualified Health Centers (FQHCs), behavioral health providers, home care agencies and hospices, nursing homes, and senior care living centers. Matt advises healthcare providers on consolidation and coordination of care, including the integration of behavioral health into the primary care delivery system. He also provides consulting solutions for providers transitioning to new value-based reimbursement models, and data driven patient care, including: developing business process and controls for collecting and advantaging data to provide analysis on: provider activity, delivery of care, and analysis of efficiency & cost effectiveness. Matt is also highly-sought after for his knowledge on issues related to affordable housing developers with requirements related to the US Department of Housing and Urban Development, MassHousing, Low Income Housing Tax Credits, Historical Tax Credits and New Markets Tax Credits.