CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 10175 (issued August 11, 2017), which provides instructions for payment to Rural Health Clinics (RHCs) billing under the all-inclusive rate (AIR),and Federally Qualified Health Centers (FQHCs) billing under the prospective payment system (PPS) for care coordination services rendered on or after January 1, 2018. The article discusses new codes for RHCs and FQHCs must use to be reimbursed for complex Chronic Care Management (CCM) services, General Behavioral Health Integration (BHI) services, and a psychiatric collaborative care model (CoCM).

The first new G code will be a General Care Management code (G0511) for RHCs and FQHCs with the payment amount set at the average of the three national non-facility PFS payment rates for the CCM and general BHI codes. The second new G code for RHCs and FQHCs will be a Psychiatric CoCM code (G0512) with the payment amount set at the average of the two national non-facility PFS payment rates for psychiatric CoCM services. The MLN Matters article states that RHC or FQHC claims submitted using CPT 99490 for dates of service on or after January 1, 2018, will be denied.

For additional information, including specific requirements for RHCs and FQHCs billing under the new General Care Management code (G0511) and Psychiatric CoCM code (G0512), please click here for the MLN Matters article, and here for the official instruction, CR 10175, issued to MACs regarding this change.