Rural Health Clinics Center
New Virtual Communication Services
Effective January 1, 2019, RHCs can receive payment for Virtual Communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an RHC practitioner to a patient who has had an RHC billable visit within the previous year, and both of the following requirements are met:
- The medical discussion or remote evaluation is for a condition not related to an RHC service provided within the previous 7 days, and
- The medical discussion or remote evaluation does not lead to an RHC visit within the next 24 hours or at the soonest available appointment.
To receive payment for Virtual Communication services, RHCs must submit an RHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes. See Virtual Communication Services Frequently Asked Questions [PDF, 39KB]
RHC face-to-face requirements are waived when these services are furnished to an RHC patient, and coinsurance and deductibles apply.
New RHC Care Management Services
Effective January 1, 2018, RHCs can receive payment for Chronic Care Management (CCM) or general Behavioral Health Integration (BHI) services when 20 minutes or more of CCM or general BHI services are furnished and G0511 is billed either alone or with other payable services on an RHC claim.
Effective January 1, 2018, RHCs can receive payment for psychiatric Collaborative Care Model (CoCM) services when 70 minutes or more of initial psychiatric CoCM services or 60 minutes or more of subsequent psychiatric CoCM services are furnished and G0512 is billed either alone or with other payable services on an RHC claim.
CCM services furnished on or before December 31, 2017 will continue to be processed and paid when CPT code 99490 is billed alone or with other payable services on an RHC claim. Service lines reported with CPT code 99490 will be denied for dates of service on or after January 1, 2018. See Care Management Services in RHCs and FQHCs - FAQs - (Updated on 01/09/2019) [PDF, 196KB] .
Questions on RHC Issues?
Billing / Payment
- Communication Technology Based Services and Payment for Rural Health Clinic (RHCs) and Federally Qualified Health Centers (FQHCs) [January 2019]: MM10843 [PDF, 202KB]
- CY 2019 Payment Rate Increase for RHCs. See MM10989 [PDF, 182KB] .
- Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers [PDF, 241KB]
- Medicare Benefit Policy Internet Only Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services - See MM11019 [PDF, 208KB]
- RHC Preventive Services Chart [PDF, 364KB] – Information on preventive services in RHCs including HCPCS coding, same day billing, and waivers of co-insurance and deductibles (Updated on 08/10/2016).
- SE1039 [PDF, 92KB] - Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
- SE1606 [PDF, 820KB] - Guidance on the Physician Quality Reporting System (PQRS) 2014 Reporting Year and 2016 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)
- Chapter 29-(T14) -- Independent Rural Health Clinic and Freestanding Federally Qualified Health Center cost Report Form CMS 222-92 (Instructions) [ZIP, 403KB]
- Quality, Safety & Oversight - General Information
- Policy & Memos to States and Regions
- Form CMS-1561A : Health Insurance Benefit Agreement - Rural Health Clinic
- Form CMS 29 : Request to Establish Eligibility to Participate in HI for Aged/Disabled to Provide Rural Health Clinic Services
Conditions for Coverage/Participation
- Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- CfC and CoP: Rural Health Clinic/Federally Qualified Health Center
- Social Security Act, Title XVIII, Section 1861(aa) - Opens in a new window - Rural Health Clinic Services and Federally Qualified Health Center Services
- Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019 - See Section III. Other Provisions of the Final Rule - C. Payment for Care Management Services and Communication Technology-Based Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 - See Section III. Other Provisions of the Proposed Rule - A. New Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)
- Previous RHC Regulations [PDF, 39KB]
Rural Research Centers
- Maine Rural Health Research Center - Opens in a new window
- North Carolina Rural Health Research and Policy Analysis Center - Opens in a new window
- North Dakota Rural Health Reform Policy Research Center - Opens in a new window
- RUPRI Center for Rural Health Policy Analysis - Opens in a new window
- South Carolina Rural Health Research Center - Opens in a new window
- University of Minnesota Rural Health Research Center - Opens in a new window
- West Virginia Rural Health Research Center - Opens in a new window
- WWAMI Rural Health Research Center - Opens in a new window
CMS Manuals & Transmittals
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
- RHC Fact Sheet
- Effective April 1, 2016, RHCs are required to report a HCPCS code for each service furnished along with an appropriate revenue code. For claims with dates of service on or after April 1, 2016, RHCs should follow the reporting requirements for modifier CG found in MLN Matters Article SE1611 [PDF, 59KB] . For additional information, see RHC Reporting Requirements FAQs.
MM10175 [PDF, 332KB]
- Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)
- MLN General Information
- MLN Matters Articles
- MLN Multimedia
- MLN Publications
- American Indian/Alaska Native
- Medicaid Information - Opens in a new window
- Partnering with CMS Center
How to Stay Informed
- Subscribe now to receive the weekly MLN Connects®
for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Rural Health Open Door Forum – For information on current rural health issues and an opportunity to ask and get your questions answered, join the Rural Health Open Door Forum calls sponsored by CMS. Sign up for call notifications.
- Press Releases - Opens in a new window
- CMS Regional Office Rural Health Coordinators (Updated 05/21/19) [PDF, 150KB]
- Medicare Certified Rural Health Clinics
- CMS Regional Survey and Certification Contacts [PDF, 92KB]
- CMS Regional Offices and HHS Regions - Map [PDF, 96KB]
External Links for Rural Health
- National Organization of State Offices of Rural Health - Opens in a new window
- National Rural Health Association - Opens in a new window
- Health Resources and Services Administration (HHS) - Opens in a new window
- National Association of Rural Health Clinics - Opens in a new window
- Rural Health Information Hub (RHI Hub) - Opens in a new window
- National Center for Frontier Communities - Opens in a new window
- National Rural Health Resource Center - Opens in a new window
- The National Rural Recruitment and Retention Network - Opens in a new window
- National Association for Rural Mental Health (NARMH) - Opens in a new window
- Kaiser Family Foundation - Opens in a new window
- The National Advisory Committee on Rural Health and Human Services - Opens in a new window
- Rural Health Research Gateway