Expansion of Services for RHCs Proposed Rule 2024 Medicare Physician Schedule

Centers for Medicare and Medicaid Services (CMS) proposed an opportunity in the CY 2024 Medicare Physician Fee Schedule (MPFS) to expand general care management services in Rural Health Clinics (RHCs).

In this CMS proposed rule, if finalized as written, will grant RHC’s the opportunity to bill for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) services, as well as general care management codes for Community Health Integration (CHI) and Principal Illness Navigation (PIN), all through the G0511 code beginning January 1, 2024.

However, if the proposed rule is finalized as written, the G0511 code will be the special payment code that represents 22 care management services. Currently RHCs are only eligible to be reimbursed for one general care management service per patient, per month. Unless CMS changes their policy to allow multiple G0511 services per patient per month this billing requirement will be disadvantage to RHC patients.

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