HCPCS code G0511: Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) – General Care Management

Learn more about the documentation and billing requirements needed to properly use and bill HCPCS code G0511 from our short guide.

Use Code

## **What is HCPCS code G0511?** HCPCS code G0511 refers to health clinic or federally qualified health center (RHC or FQHC), general care management. It is used to bill for general care management services in RHCs and FQHCs allows for improved patient outcomes. To add, the code represents 20 minutes or more of clinical staff, healthcare provider, or other qualified health care professional time per calendar month, directed by a physician, nurse practitioner (NP), physician assistant (PA), or other qualified healthcare professional. G0511 bundles a number of different care management and monitoring services. It was created to simplify billing for FQHCs and RHCs. The services included under this code may consist of: - **Chronic Care Management services (CCM) or Chronic Pain Management (CPM)**: For patients with two or more chronic conditions that are expected to last at least 12 months. - **Principal Care Management services (PCM)**: For patients with a single, high-risk chronic condition. - **Behavioral Health Integration services (BHI)**: For integrating mental health care with primary care. - **Remote Patient Monitoring services (RPM)**: For monitoring patient health data from a distance, such as blood pressure or weight. - **Remote Therapeutic Monitoring services (RTM)**: For monitoring patient-reported data on therapeutic response or adherence. - **Community Health Integration services (CHI)**: For supporting patients with social and community-based health needs. - **Principal Illness Navigation services (PIN)**: For helping patients and caregivers navigate treatment for a serious or high-risk condition, including resource coordination and care transitions. - **Remote Physiologic Monitoring (RPM)**: For tracking physiologic data such as heart rate, oxygen saturation, or glucose levels, and transmitting it electronically to providers for ongoing management. The code is paid at a single rate, which is the average of the Physician Fee Schedule (PFS) rates for the underlying services.

## **Documentation requirements** To support billing G0511, records must include: - **Patient eligibility**: At least one chronic condition expected to last ≥12 months or until death, or a diagnosed mental/behavioral health condition. - **Comprehensive care plan**: A personalized care plan must be established, implemented, and regularly updated. This plan should include a problem list, measurable goals, planned interventions, and coordination with other providers. - **Time tracking**: ≥20 minutes of care coordination services related to the aforementioned services above furnished under supervision in the given month. - **Patient consent**: Verbal or written consent for care management services must be obtained and documented in the patient's record. This should inform the patient about the services, the 20% cost-sharing, and their right to stop the services at any time. - **Service details**: The documentation should clearly describe the specific services provided under G0511, such as care plan updates, medication management discussions, or behavioral health assessments. - **Care coordination activities**: medication reconciliation, referrals, communication with specialists, health education, and 24/7 access to care. - **Medical history:** The patient's complete medical history, with a focus on the chronic conditions being managed, must be documented. - **Provider oversight**: evidence of ongoing physician/NP/PA involvement.

## **Billing requirements** To prevent claim denials, the following billing requirements for HCPCS code G0511 must be met: - Payment is per 20 minutes of clinical staff time—not per encounter. - If multiple care management services are provided in a month, only one claim line is billed under G0511. - Only RHCs and FQHCs can bill using HCPCS code G0511. The services must be directed by a qualifying practitioner (physician, nurse practitioner, physician assistant, or certified nurse midwife). - The code can be billed multiple times in a calendar month if the requirements for the underlying services are met separately and resource costs are not double-counted. - CMS required RHCs and FQHCs to transition from G0511 to billing individual care management CPT codes, with the change taking effect after September 30, 2025.

## **Other relevant codes** - **G0512**: Psychiatric collaborative care management (60 minutes/month) - **G0506**: Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)

Frequently asked questions

No. Services may be provided via non-face-to-face care coordination, phone calls, or electronic communications.

Yes, G0511 is a non-face-to-face service and can be billed in the same month as a face-to-face visit. However, the time spent on G0511 services must not be counted as part of the time for the face-to-face visit.

While both are for RHCs and FQHCs, G0511 covers general care management services (including BHI), while G0512 is specifically for the Psychiatric Collaborative Care Model (CoCM), which involves more extensive psychiatric care coordination.