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Rural Health Clinics Center

Spotlights

  • 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.

    RHC face-to-face requirements are waived when these services are furnished to an RHC patient, and coinsurance and deductibles apply.

  • 2018 Update - Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 581KB] and MM10350 [PDF, 181KB] . 
  • 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.

    Care Management Services in RHCs and FQHCs - FAQs - (Updated on 2/27/2018) [PDF, 212KB]

    Additional Information - MM10175 [PDF, 332KB]   and Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program

  • 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.
  • RHC Preventive Services Chart [PDF, 364KB]  - (Updated on 08/10/2016)
  • 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.

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Important Links

Billing / Payment

Enrollment/Certification

Conditions for Coverage/Participation

Legislation

Regulations

  • CMS-1443-F (Text Version) - Opens in a new window - Prospective Payment System for Federally Qualified Health Centers; Changes to Contracting Policies for Rural Health Clinics; and Changes to Clinical Laboratory Improvement Amendments of 1988 Enforcement Actions for Proficiency Testing Referral; Final Rule with Comment; Published May 2, 2014.
  • CMS-1443-P (Text Version) - Opens in a new window – Prospective Payment System for Federally Qualified Health Centers, Changes to Contracting Policies for Rural Health Clinics; and Changes to Clinical Laboratory Improvement Amendments of 1988 Enforcement Actions for Proficiency Testing Referral; Proposed Rule; Published September 23, 2013.
  • CMS-3267-P (Text) - Opens in a new window - Part II--Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Proposed Rule; Published February 7, 2013.
  • CMS-1910-P2 (Text) - Opens in a new window - Changes in Conditions of Participation Requirements and Payment Provisions; Rural Health Clinics and Federally Qualified Health Centers; Published June 27, 2008.
  • CMS-1910-IFC (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Suspension of Effectiveness; Published September 22, 2006.
  • CMS-1910-F (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program; Published December 24, 2003.
  • HCFA-1910-P (Text) - Opens in a new window - Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program: Published February 28, 2000.

External Links for Rural Health

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