With the 2024 CMS rule updates, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) can bill for multiple instances of the G0511 CPT code where previously it was only once.

Multipliers will be added to CPT code G0511 per successful instance of meeting time logging thresholds within the following programs: CCM, BHI, RPM, PCM

NOTE: Minutes for CCM, BHI, and RPM programs cannot be combined from one program into another to reach the minutes for one program's billing claim threshold.

To view a successful G0511 billing code, first enter a number of minutes that will meet the billing threshold through a program’s time logger on a patient chart.

Click the ‘Log Time’ button and then click on the ‘Billing’ tab under the patient information section.

For billing and claims, program names will be removed from claims and instead the user will see only one type of claim, G0511. The CPT code will display as 'G0511 - General Care.'

When a program reaches an additional billing claim threshold for G0511, a multiplier will be added to the G0511 billing claim such as '2 x G0511 - General Care.'

A G0511 billing claim will be created for the first 20 minutes logged into the CCM program.

When another 20 minutes is logged into the CCM program or 40 minutes total, a multiplier will be added to the G0511 Billing Claim.

When another 20 minutes is logged into the CCM program or 60 minutes total, a multiplier will be added to the G0511 Billing Claim.

Once 60 minutes have been achieved in the CCM program, a multiplier will only be added for every 30 additional minutes logged into the CCM program.

NOTE: There is no cap on CCM G0511 multipliers if the billing claim thresholds are met.

RPM claims will be time-based and not based on the # of days of readings submitted within 30 days.

A G0511 billing claim will be created for the first 20 minutes logged into the RPM program.

Every additional 20 minutes logged into the RPM program will add a multiplier to the G0511 billing claim.

NOTE: There is no cap on RPM G0511 multipliers if the billing claim thresholds are met.

Only one 20 minute claim can be logged for the G0511 Billing Claim in the BHI program.

A G0511 billing claim will be created for the first 30 minutes logged into the PCM program.

Every additional 30 minutes logged into the PCM program will add a multiplier to the G0511 billing claim.

NOTE: There is no cap on PCM G0511 multipliers if the billing claim thresholds are met.

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