What FQHCs and RHCs Need to Know About the 2024 Final Physician Fee Schedule

The verdict is in. The 2024 Final Medicare Physician Fee Schedule was released on November 2, 2023. The good news is that CMS confirmed starting January 1, 2024, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) will be able to receive payment for remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), a move that promises to enhance patient care and expand telehealth service offerings.

FQHCs and RHCs Can Bill for RPM and RTM Under General Management Code HCPS G0511

Providers will be eligible to receive payment for two remote health monitoring services under the general care management code G0511 at $72.98 per patient per month. FQHCs and RHCs can provide and bill for both services to the same patient in the same month. This further expands the code, which already included non-face-to-face services such as chronic care management (CCM) and behavioral health integration services (BHI).

Providers May Bill Multiple Times Per Month for G0511

The final rule also states that FQHCs and RHCs can bill G0511 multiple times monthly for the same patient if all the minimum requirements are met for each subcategory code. For example, a provider will be able to bill for a patient who is enrolled in a CCM and a remote patient monitoring program as long as the requirements are met for each service.

Reduction in G0511 Reimbursement Rate

Despite a reduction in the reimbursement rate for G0511 from $77.94 in 2023 to $72.98 in 2024, CMS anticipates a positive impact from these changes. The expanded access to RPM, RTM, and BHI services is expected to outweigh the effects of the rate reduction, offering patients broader access to essential healthcare services.

Expanded Coverage is Expected to Continue for RPM and RTM

These changes are great news for FQHCs, RHCs and their Medicare beneficiaries. It is also expected that many Medicaid plans will follow. Review individual state Medicaid policies here.

Overall, the CMS Physician Fee Schedule 2024 is expected to have a positive impact on patient care. FQHCs and RHCs who were previously unable to participate in RPM or RTM will now be able to earn reimbursement for delivering enhanced care, and more patients will benefit.