From the Research
The G codes for Chronic Care Management (CCM) billing in a Rural Health Clinic (RHC) are G0511 and G0512, with G0511 requiring at least 20 minutes of clinical staff time per calendar month and G0512 requiring at least 70 minutes of initial psychiatric CoCM in the first calendar month. When billing these codes in an RHC setting, they are considered care management services and are billed as stand-alone billable visits. The payment for G0511 is based on the average of CPT codes 99490, 99487, 99484, and 99491, while G0512 payment is based on the average of CPT codes 99492 and 99493, as supported by recent studies 1, 2. These codes allow RHCs to receive appropriate reimbursement for the time-intensive care coordination services provided to patients with multiple chronic conditions, which helps improve patient outcomes through better care management while ensuring the financial sustainability of these essential rural healthcare facilities. Some studies have shown that CCM services can improve clinical outcomes, enhance patients' adherence with medical treatments, reduce overall cost, and increase patient satisfaction 1. However, other studies have indicated that CCM services are underutilized, with only a small percentage of primary care providers billing for these services 3, 2. Despite these challenges, the use of CCM codes can help RHCs to provide high-quality care to their patients while also ensuring the financial sustainability of their operations. Key points to consider when billing for CCM services in an RHC setting include:
- Ensuring that patients meet the eligibility criteria for CCM services
- Obtaining patient consent for CCM services
- Providing at least 20 minutes of clinical staff time per calendar month for G0511 and at least 70 minutes of initial psychiatric CoCM in the first calendar month for G0512
- Billing CCM services as stand-alone billable visits
- Using the correct CPT codes to determine payment for G0511 and G0512, as supported by studies 4, 5.