Along with changes to equipment modifiers and CPT Category III codes, July will also introduce a few changes to health center codes used by RHCs (rural health centers) and FQHCs (federally qualified health centers). These updates will change the indicators for two care management codes as outlined below. Under these changes, the PC/TC indicators (professional component / technical component) for two HCPCS Level II codes will change to 0 (Full service only (physician service codes) modifiers 26 and TC are not valid).
This change will apply to the two common health center codes listed below:
G0511: Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month.
G0512: Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric CoCM), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month.
Since January 1st of this year, RHCs and FQHCs have been required to use these health center codes for billing chronic care management and general behavior health information services (in the case of G0511) and for billing the psychiatric collaborative care model (in the case of G0512). If you work for an RHC or an FQHC, be sure to review these changes so that you will be ready to apply the updates come July. From there, be sure to also share the updates with your coworkers so that all practices and facilities can continue to offer the best possible level of healthcare.