2018 New Care Coordination Services and Payment for FQHCs

The Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule for 2018. The final rule includes important provisions for FQHCs and is intended to improve payment for the professional work of care management services through the establishment of separate payment rates for collaborative care. 

The final 2018 Physician Fee Schedule allows for reimbursement to FQHCs for the delivery of care management services for patients with behavioral health issues, psychiatric conditions, and substance use disorder. Care management services include:

• Transitional Care Management (TCM)
• Chronic Care Management (CCM) 
• General Behavioral Health Integration (BHI) 
• Psychiatric Collaborative Care Model (CoCM)  

FQHCs must submit claims with new G codes for the delivery of CCM, behavioral health integration (BHI), and a psychiatric collaborative care model (CoCM).  These G codes were created to allow for consistency with the FQHC payment principles of bundling services to support the provision of care management services.  The payment amounts are based on the Physician Fee Schedule national non-facility rates and are not subject to the Geographic Adjustment Factor.  The new 2018 General Care Management and psychiatric CoCM G codes and payment rates are as follows: 

• TCM: Same as payment for FQHC visit
• General Care Management (G0511): 2018 rate $62.28 (national average rate of CPT codes 99490, 99487 and 99484)
• Psychiatric CoCM (G0512): 2018 rate $145.08 (national average rate of 99492 and 99493)

Care management services may be billed per calendar month either alone or in addition to other services provided during the FQHC visit.  FQHCs will continue to receive payment for CCM services when CPT code 99490 is billed alone or with other payable services for dates of service on or before December 31, 2017.  The final rule, including details on clinical and billing requirements, may be accessed here. 

What Does CohnReznick Think?

FQHCs should review the final rule to understand the financial impact and benefit to the Center and its patients. Changes to service delivery, as well as configuration changes required to the practice management system, will be required to allow for reimbursement under the new G code requirements.  Furthermore, internal reporting must also be updated to capture and track reimbursement trends.

Contact

For more information, please contact Peter Epp, Partner, Healthcare Industry Practice Leader, at [email protected] or 646-254-7411, or Dolores Di Re, Senior Manager, at [email protected] or 646-625-5703.