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Rural Health Clinics Center

Spotlights
  • Preventive Services

    Payments to RHCs and FQHCs for covered RHC and FQHC services furnished to Medicare beneficiaries are made on the basis of an all-inclusive rate (AIR) per covered visit. Information on preventive services payable under the AIR is available in CMS Pub 100-04, Chapters 9 and 18.

    The chart below lists preventive services that are eligible to be paid based on the provider’s AIR when billed without another covered visit.

     

    Service

    HCPCS Code

    Long Descriptor

    Eligible service paid at the AIR

    Coinsurance/Deductible

    CMS Pub 100-04

    Initial Preventive Physical Examination (IPPE)

    G0402*

    Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment

    Yes

    Waived

    Ch 9 §150

    Ch 18 §80

    Diabetes Self-Management Training (DSMT)

    G0108*

    Diabetes outpatient self-management training services, individual, per 30 minutes

    Yes

    (FQHCs only)

    Not

    Waived

    Ch 9 §181

    Ch 18 §120

    Medical Nutrition Therapy (MNT)

    97802*

    Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

    Yes

    (FQHCs only)

    Waived

    Ch 9 §182

    97803*

    Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

    Yes

    (FQHCs only)

    Waived

    G0270*

    Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes

    Yes

    (FQHCs only)

    Waived

    Annual Wellness Visit

    G0438

    Annual wellness visit, including PPPS, first visit

    Yes

    Waived

    Ch 18 §140

    G0439

    Annual wellness visit, including PPPS, subsequent visit

    Yes

    Waived

     

    * This service is payable with another encounter/visit on the same day at the provider’s AIR.

  • The Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) has been updated to include new information on Transitional Care Management, Hospice payment exceptions, and RHC employment, and provides clarification of existing information and is effective January 1, 2014.
  • Vaccination is the Best Protection Against the Flu [PDF, 414KB]
  • SE1039Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
  • Medicare Rural Health Clinics Waiver of Coinsurance and Deductible Claim Processing Issue:  The Centers for Medicare & Medicaid Services (CMS) has identified an issue when Healthcare Common Procedure Coding System (HCPCS) codes are reported for preventive services recommended by the United States Preventive Services Task Force (USPSTF) with a grade of A or B on Rural Health Clinic claims (71X) for dates of service on or after January 1, 2011. Since the additional revenue line(s) are not separately payable, the contractors have been instructed to move the charges associated with these revenue lines to the non covered field and to override reason code 31577. This will allow the claim to continue processing and not delay payments. After the changes for CR 7208, transmittal 2122, are implemented on April 4, 2011, contractors will mass adjust these claims to ensure the charges are reflected as covered. Providers should not attempt to resubmit affected claims as their FI or MAC will be initiating adjustments for the sole purpose of correcting the charges. Providers should anticipate the initiation of these adjustments within 30 calendar days after the implementation of CR 7208.

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