Still Billing G0511? What Primary Care Practices Need to Know for 2026

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If your primary care practice is still using HCPCS code G0511 , it is time to review your billing workflow. CMS ended the temporary allowance to bill G0511 for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) after September 30, 2025 . Beginning October 1, 2025, these organizations were required to report the individual CPT and HCPCS codes describing the applicable care coordination services instead of the single G0511 code. For 2026, this means G0511 should no longer be part of the standard billing workflow for these care coordination services. Practices that have not updated their systems may face claim rejections, incorrect billing, or lost reimbursement opportunities. For a detailed explanation of what replaced G0511, see What Replaced G0511? A Primary Care Guide to CY2026 APCM . Why G0511 Is No Longer the Right Billing Approach G0511 was previously used by RHCs and FQHCs as a general care management billing code. CMS changed this approach as part of its e...
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Correct Use of Modifiers for Podiatry Services

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Improper use of Modifiers for Podiatry Services can be the cause of claim denials just as not using a modifier can be. When using modifiers, make sure you clearly understand what the modifier entails. Sometimes, there are related services that the physician is performing, global periods to contend with, etc. Modifiers will clarify extenuating circumstances, which should allow for payment when they otherwise may not.

If the insurance company denies a claim and you rebill it by simply choosing another modifier and hoping that is the correct one, this will usually end up creating additional problems. Insurance companies may have a time limit as to how long you can file an appeal. If you continually rebill incorrectly, then by the time you send in the claims and subsequently get denied again, you may run out of the appeal window. The appeal window generally starts when you submit the initial claim. Medicare explanation of medical benefits (EOMBs) will indicate whether you can appeal a claim rather than rebill, depending on the error.

There are three specific evaluation and management (E/M) modifiers. These are the -24, -25, and -57 modifiers. Only use these modifiers with E/M services. If you append them to any other service such as a diagnostic study or procedure, the carrier will automatically deny your claim.

Modifiers for Podiatry Services are:

Modifier 24:

Unrelated Evaluation and Management by the same physician during a postoperative period. When an unrelated E/M service is performed by the same physician during the postoperative (global period -10 or 90-day postoperative period) then append modifier 24 to the E/M procedure code. Make sure that we are not assigning the same diagnosis code which is the reason for the surgery which was performed earlier, and then there would be the chance of the claim getting denied.

To know more about the Correct Use of Modifiers for Podiatry Services, click here: https://bit.ly/3KhgRMc Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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