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CMS ANNOUNCES NEW FQHC

CARE MANAGEMENT SERVICES FOR 1/1/2018

 

CMS made an announcement regarding New FQHC Care Management Services.  Effective January 1, 2018, FQHCs can receive payment for the following:

·       Chronic Care Management (CCM) or general Behavioral Health Integration (BHI) services when 20+ minutes of CCM or general BHI services are furnished and G0511 is billed either alone or with other payable services on FQHC claim.

·       Psychiatric Collaborative Care Model (CoCM) services when 70+ minutes of initial psychiatric CoCM services or 60+ minutes of subsequent psychiatric CoCM services are furnished and G0512 is billed either alone or with other payable services on FQHC claim.

 

Care Management Services, which are considered FQHC services (in addition to any routine care coordination services already furnished as part of an FQHC visit), include the following:

·       Transitional Care Management (TCM)

·       Chronic Care Management (CCM)

·       General Behavioral Health Integration (BHI)

·       Psychiatric Collaborative Care Model (CoCM)

 

TCM: 1/1/2018, TCM services can be billed by adding CPT code 99495 or CPT code 99496 to an FQHC claim, either alone or with other payable services. If it is the only medical service provided on that day with a FQHC practitioner it is paid as a stand-alone billable visit. If it is furnished on the same day as another visit, only one visit is paid - Same as payment for an FQHC visit.

 

CCM: 1/1/2018, CCM services can be billed by adding the general care management G code, G0511, to an FQHC claim, either alone or with other payable services. Payment is set annually at the average of the national non-facility PFS payment rate for CPT codes 99490 (20+ minutes of CCM services), 99487 (60+ minutes of complex CCM services), and 99484 (20+ minutes of general BHI services) - The 2018 rate is $42.84.

 

General BHI: 1/1/2018, general BHI services can be billed by adding the general care management G code, G0511, to an FQHC claim, either alone or with other payable services. Payment is set annually at the average of the national non-facility PFS payment rate for CPT codes 99490 (20+ minutes of CCM services), 99487 (60+ minutes of complex CCM services), and 99484 (20+ minutes of general behavioral health integration services) - The 2018 rate is $62.28.

 

Psychiatric CoCM: 1/1/2018, psychiatric CoCM services can be billed by adding the psychiatric CoCM G code, G0512, to an FQHC claim, either alone or with other payable services. Payment is set annually at the average of the national non-facility PFS payment rate for CPT codes 99492 (70+ minutes of initial psychiatric CoCM services) and CPT code 99493 (60+ minutes of subsequent psychiatric CoCM services) – The 2018 rate is $145.08.

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