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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0511-rhc-fqhc-chronic-care-behavioral-health-management
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    HCPCS G0511: RHC/FQHC General Care Management, ≥20 Minutes

    HCPCS Level II code G0511 represents monthly general care management services provided by a rural health clinic (RHC) or federally qualified health center (FQHC), covering 20 minutes or more of clinical staff time per calendar month for chronic care management or behavioral health integration services directed by an RHC or FQHC practitioner (physician, nurse practitioner, physician assistant, or certified nurse midwife); service type: care management / behavioral health integration, typical site of service: rural health clinic or federally qualified health center outpatient setting.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with multiple chronic conditions (type 2 diabetes with neuropathy, hypertension, and major depressive disorder) is enrolled at a federally qualified health center (FQHC) in a rural county. The patient has difficulty traveling for frequent office visits and receives monthly chronic care management and behavioral health integration services directed by the FQHC practitioner (physician or nurse practitioner). Clinical staff (medical assistant and behavioral health coordinator) spend 25 minutes this month on tasks including medication reconciliation, outreach for medication adherence, coordination with the patient’s pharmacy, brief telephonic symptom monitoring for depression, updating the problem list and care plan in the electronic health record, and scheduling a follow-up behavioral health visit. The practitioner oversees and reviews the care plan, documents authorization for the clinical staff activities, and signs off on the monthly management note as required.

    Typical workflow:

    • Patient identified as eligible for monthly general care management/behavioral health integration at intake and during chronic disease registry review.

    • Practitioner directs care team to provide remote and in-person services; clinical staff track time spent on non-face-to-face care management activities.

    • Clinical staff perform medication reconciliation, patient education, and telephonic follow-up; behavioral health staff perform brief assessments and coordinate referrals.

    • Practitioner reviews the monthly summary, documents oversight, and approves billing for the month when at least 20 minutes of clinical staff time is documented and attributable to this patient.

    • Billing for this service is submitted under code G0511 per calendar month for RHC/FQHC-only settings when time and supervision criteria are met.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99490Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar monthAlternative non-RHC/FQHC Medicare CPT code for similar monthly chronic care management services; often coordinated with G0511 in practices serving non-RHC/FQHC patients.
    99487Complex chronic care management services, first hour of clinical staff time directed by a physician or other qualified health care professional, per calendar monthUsed when patients require more intensive, complex care coordination exceeding typical monthly management and may prompt additional services beyond G0511.
    99492Psychiatric collaborative care management, first 70 minutes in the first calendar monthRelated when formal psychiatric collaborative care models are used; behavioral health integration components billed under G0511 may interface with collaborative care codes for specialty involvement.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207T00000XNeurological Surgery PhysicianA neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and reh…
    207RP1002XPhysician Nutrition Specialist (Internal Medicine)A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…
    261QR0400XRehabilitation Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    207RM1200XMagnetic Resonance Imaging (MRI) Internal Medicine PhysicianThe NUCC recommends this code not be used. Choose a more appropriate code.<br/>
    2471C3402XRadiography Radiologic TechnologistA radiologic technologist who specializes in radiography (also known as x-rays) and is appropriately educated and trained, consistent with nationally …

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    E78.5Hyperlipidemia, unspecified
    F06.8Other specified mental disorders due to known physiological condition
    F17.210Nicotine dependence, cigarettes, uncomplicated
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F41.1Generalized anxiety disorder
    F43.10Post-traumatic stress disorder, unspecified

    Showing 1–10 of 28

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    99484Care management services for behavioral health conditions, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar monthOverlaps with behavioral health integration activities described under G0511 for non-RHC/FQHC settings; informs clinical workflows and documentation standards.
    G0071Payment for an RHC visit (facility)Facility visit code used in RHC settings for face-to-face visits; G0511 is billed in addition to or separate from standard RHC visit reporting when monthly management criteria are met.