Saving Money and Expanding Care at FQHCs
A 2016 study of 13 states showed that the majority of FQHCs demonstrated Medicaid savings when compared to other primary care settings. FQHCs did this through lowering Emergency Department use and general decreases in spending.(1) One of the keys to controlling spending is that providers are paid a flat salary and they do not code for higher levels of service.(2) As of January 1, 2018, CMS has extended this method of billing for ccp with the creation of billing code G0511.(3)
As discussed in our September post, “Implementing Chronic Care Management at FQHCs: Changes for 2018,” billing G0511 will be initiated on January 1, 2018. Like other FQHC codes, G0511 incorporates multiple codes to keep costs down. The three CPT codes that fall under the G0511 umbrella are 99490, 99487, and 99484. This means that reimbursement for all chronic care management and collaborative care management for behavioral health is the same rate. CMS has set this rate at approximately $61.00.(4) This is a 50% increase over the average reimbursement rate for 99490.