CMS Pub. 100-04, ch. 9, § 70.7

Collaborative Care Model (CoCM) Services

(Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25)

Effective for services furnished on or after January 1, 2018, RHCs and FQHCs are paid

for Care Coordination Services or Psychiatric CoCM services when G0511 or G0512 is

billed alone or with other payable services on an RHC or FQHC claim. HCPCS code

G0511 or G0512 can only be billed once per month per beneficiary and cannot be billed

if other care management services are billed for the same time frame.

HCPCS codes G0511 and G0512 are subject to coinsurance and deductibles on RHC

claims. Only coinsurance applies on FQHC claims. Coinsurance is 20 percent of the

lesser of the RHC or FQHC charge for HCPCS codes G0511 and G0512, or the

corresponding rate.

The allowable revenue code is 052X. These HCPCS codes of G0511 or G0512 should

not be billed with modifier CG for payment on RHC claims.

Effective for services furnished on or after January 1, 2025, RHCs and FQHCs shall bill

the individual CPT and HCPCS codes that describe care coordination services instead of

the single HCPCS G0511. However, there is a delay in compliance of this requirement

for 6 months at least until July 1, 2025, for RHCs and FQHCs to update their billing

systems if necessary. During the 6-month delay (January 1, 2025 – July 1, 2025), RHCs

and FQHCs may continue to bill HCPCS G0511 for care coordination services, after

which they will be required to bill the individual HCPCS codes.

RHCs and FQHCs shall determine on a facility level basis whether they are continuing to

bill G0511 or the individual HCPCS codes and not by a claim by claim or patient by

patient basis.

Since the Advanced Primary Care Management (APCM) services are not included in

G0511, when furnishing APCM, RHCs and FQHCs shall report G0556, G0557, G0558

as appropriate effective January 1, 2025.

The services should be submitted as:

• Type of bill (TOB) 71X (RHC) or 77X (FQHC)

• Revenue code 052X,

• The care coordination services HCPCS codes,

• for TOB 71X with or without modifier CG

Care coordination services that can be furnished and paid separately in RHCs and FQHCs

effective January 1, 2025:

• Chronic Care Management (CCM) – 99437, 99439, 99487, 99489, 99490, 99491

• Principal Care Management (PCM) - 99424, 99425, 99426, 99427

• Chronic Pain Management (CPM) - G3002, G3003

• General Behavioral Health Integration (BHI) - 99484, G0323

• Remote Physiological Monitoring (RPM) - 99453, 99454, 99457, 99458, 99474,

99091

• Remote Therapeutic Monitoring (RTM) - 98975, 98976, 98977, 98980, 98981

• Community Health Integration (CHI) - G0019, G0022

• Principal Illness Navigation (PIN) - G0023, G0024

• PIN-Peer Support (PS)- G0140, G0146

• Advanced Primary Care Management (APCM) – G0556, G0557, G0558

Coinsurance and deductibles apply to RHC claims, and coinsurance applies to FQHC

claims for these services.