Reimbursement
$72.00
Threshold
N/A
2026 Status
Deleted
What is CPT Code G0511?
CPT G0511 is defined as: HCPCS G0511 was previously used by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) as a composite code for general care management services, including CCM, RPM, and BHI. Effective January 1, 2026, this code has been terminated (sunsetted) by CMS as part of a move toward itemized, resource-specific billing for safety-net providers.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0
Physician Effort
PE (Non-Fac)
0
Practice Expense
Malpractice
0
Risk Factor
Total RVU
0
Note: Code Terminated - Reimbursement is $0.00. Refer to itemized CPT codes.
2026 CMS Policy Intelligence
termination rationale
CMS sunsetted G0511 to ensure that FQHCs and RHCs are reimbursed equitably for high-intensity services (like Complex CCM) which were previously underpaid under the blended G0511 rate.
unbundling opportunity
Facilities performing high-complexity care management will see a revenue increase by billing specific codes (e.g., 99487) rather than the lower blended rate of G0511.
conversion factor
Payment for the replacement codes utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Operational Requirements
transition mandate
Effective 2026, FQHCs and RHCs must transition from the blended rate of G0511 to itemized billing using standard CPT codes.
itemized equivalents
For 20 mins of CCM: Bill CPT 99490, For 60 mins of Complex CCM: Bill CPT 99487, For 20 mins of RPM: Bill CPT 99457, For RPM Device Supply: Bill CPT 99454
no grace period
Claims submitted with G0511 for 2026 dates of service will be denied for 'Invalid Code'.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
G0511 is TERMINATED. Facilities must immediately upgrade billing systems to handle itemized CPT codes.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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