Care management services have become one of the most efficient and effective ways to provide ongoing care to patients between traditional or remote doctor's office visits. These services have also provided organizations with meaningful and growable revenue. To help you better understand your billing opportunities for care management services, we've put together a helpful, detailed resource that provides the 2024 Medicare non-facility reimbursement rates for care management services including:
Fill out the form on this page to receive this resource. The guide is broken out by care management service, with a chart providing each service's applicable CPT and/or HCPCS codes, short descriptions of these codes, and then the 2024 non-facility Medicare reimbursement rate associated with every code.
The 2024 edition of this remote care management coding and billing resource includes several noteworthy additions. In the 2024 Medicare Physician Fee Schedule (PFS) final rule, CMS announced it would begin reimbursing for remote patient monitoring and remote therapeutic monitoring when furnished by federally qualified health centers (FQHCs) and rural health clinics (RHCs), starting in 2024. RPM and RTM are now included in the general care management HCPCS G0511.
The PFS final rule also confirmed CMS's plans to cover two new care management services. Community health integration (CHI) focuses on addressing any social determinants of health (SDOH) needs interfering with diagnosis or treatment of a patient's problems identified during an initiating visit. CHI has three HCPCS codes: G0019, G0022, and G0511. You'll find short descriptions and reimbursement rates for these CHI G-codes in the Prevounce resource.
Principal illness navigation (PIN) services can be furnished following an initiating provider visit to establish or affirm a treatment plan for at least one serious, high-risk condition expected to last three-plus months. Examples include cancer, mental health conditions, and substance abuse disorder. PIN has five HCPCS codes: G0023, G0024, G0140, G0146, and G0511. You'll also find short descriptions and reimbursement rates for the PIN G-codes in the resource.
With CMS including CHI and PIN in G0511, FQHCs and RHCs can provide and bill for these new care management services. G0511 has a 2024 non-facility reimbursement rate of about $73.
You can learn more about these and the other significant remote care management changes finalized in the 2024 Medicare PFS final rule in this webinar.
* Disclaimer: This resource is for informational purposes only and does not constitute legal or other professional advice. Billing and coding requirements – especially in the care management space – can change and be reinterpreted often. You should always consult an attorney and/or medical billing professional prior to submitting claims for services to ensure that all requirements are met.