2024 Medicare Physician Fee Schedule Quick Reference Guide

Telehealth

Continued payment for telehealth furnished by FQHCs as allowed during PHE though December 31, 2024. This includes payment for audio only telehealth services.
Delay of in person requirements for mental health visits until January 1, 2025.
CMS will continue to allow providers to list their work addresses on their Medicare enrollment form while billing telehealth services from their home until December 31, 2024.

Providers

Licensed Marriage and Family Therapists (LMFTs) and Licensed Mental Health Counselors (LMHCS) are included as distant site practitioners for purposes telehealth. They are added to the list of core Medicare FQHC clinicians and will generate a billable (PPS) visit.
Addiction counselors who meet the requirements of MFCs are eligible to enroll as Medicare providers.
The change in provider applies to Medicare and Medicaid.
Nurse Practitioners are no longer required to have primary care certification to work in an FQHC.

G0511 Final billing amount: $72.98

Remote Patient Monitoring/ Remote Therapeutic Monitoring

FQHCs will be able to bill for RPM/RTM under the general management HCPCS code G0511.
Monitoring must occur over a minimum of 16 days over a 30-day period (reported only once during a 30-day period and only one practitioner can bill CPT codes 99453 and 99454 or CPT codes 98976, 98977, 98980 and 98981 during a 30-day period). This does not apply to treatment management codes.
Practitioners can bill RPM or RTM concurrently with Chronic Care Management (CCM), Transitional Care Management (TCM), Behavioral Health Integration (BHI), Principal Care Management (PCM), and Chronic Pain Management (CPM), but not both RPM and RTM.
If a patient receives RPM and RTM together and multiple devices are used:
- Services associated with all the medical devices can be billed by only one practitioner or provider only once per patient, per 30-day period,
- Only when at least 16 days of data have been collected, and
- The services must be reasonable and necessary
May only be furnished to established patients
- Consider patients who received RPM only through the PHE as established patients.

Community Health Integration (CHI)

CHI services performed by certified or trained auxiliary personally (including CHWs), incident to the professional services under the general supervision of the billing practitioner in the bundle G0511 code will be covered.
A CHI visit must follow an initiating E/M visit in which the practitioner identifies the presence of SDOH needs that significantly limit the practitioner’s ability to diagnose or treat the problems addressed in the visit.
Requires patient consent prior to providing CHI services (can be obtained verbally if documented in record, or a written – cost share may apply).
Two codes:
- G0019 (main code): 60 minutes/month
- G0022: additional 30 minutes
  - No frequency limitation for G0022

Principle Illness Navigation (PIN) Services

Certified or trained auxiliary personnel under the direction of a billing practitioner (general supervision), which may include a patient navigator or certified peer specialist provide navigation as part of the treatment plan for serious, provide services to patients with a high-risk disease expected to last at least 3 months that places the patient at significant risk of hospitalization or nursing home placement, acute exacerbation or decompensation, functional decline or death.
Must follow E/M visit by billing practitioner.
Requires patient consent prior to providing PIN services (can be obtained verbally if documented in record, or a written – cost share may apply).
PIN is added to general care management code G0511
- G0023 – 60 minutes/month
- G0024 – additional 30 minutes

Chronic Care Management

Informed consent must be received prior to start of the services
Consent can be obtained verbally if documented and includes notification of the required services and can be collected while CCM is initiated by auxiliary staff.

SDOH Health Risk Assessment in the Annual Medicare Wellness Visit

Risk assessment is added as an optional element of the AWV
Tool used for the risk assessment must be standardized, evidence-based (ex: PRAPARE)
There is no additional payment for this screening as part of the AWV unless provided through telehealth (bill with telehealth service)
When SDOH assessment is furnished with another qualifying visit (non-AWV) on the same day in an FQHC, only the visit will be paid under the FQHC PPS, and coinsurance will be applicable to the patient.
- More guidance is coming for furnishing SDOH screening outside of AWV.
While CMS has created a G-Code for SDOH Health Risk Assessment that is a standalone code, this code is not applicable for FQHCs.

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