We recently discovered we’ve been paying the following transition of care codes* when billed by FQHC / RHC / THCs for Medicaid, when we shouldn’t:
- G0323: General Behavioral Health Integration (GBHI) services
- G0512: Rural Health Clinic or Federally Qualified Health Center (RHC/FQHC) only, psychiatric collaborative care model (psychiatric COCM)
- 99484: General behavioral health integration
- 99490: Chronic care management services
- 99492: Initial psychiatric collaborative care management
- 99493: Subsequent psychiatric collaborative care management
- 99494: Initial or subsequent psychiatric collaborative care management,
- 99495: Transitional care management services
- 99496: Transitional care management services
- 99487: Complex chronic care management services
We began mistakenly paying these codes for claims submitted after Jan. 1, 2025.
There's nothing you need to do. We’ve corrected our system to pay appropriately (see below) and will reprocess the impacted claims to pay $0, recouping the funds paid per our corrections to payments policy.
Payments for transitions of care for FQHC / RHC / THC will go back to how they were in 2024 and earlier, when we pay for the office visit (i.e., G0467) plus the following care management codes when appropriate: G9001-G9008 and 98966-98968.
*Note: This update won’t impact the 2025 PCP Incentive Program (PIP). These codes – when billed by FQHC / RHC / THC for Medicaid – will still count towards the 2025 PIP care management incentive’s target even if they won’t incur a fee-for-service payment.