- End of the COVID-19 Public Health Emergency (PHE)
-
The COVID-19 PHE ended on May 11, 2023. View RHCs and FQHCs: CMS Flexibilities to Fight COVID-19 for information about the changes to the RHC and FQHC flexibilities.
COVID-19 Vaccines & Billing
Get information about how to bill for COVID-19 vaccines.
Virtual Communication Services & Digital Assessment Services
Starting May 12, 2023, digital assessment services are no longer included in virtual communication services.
Don’t submit claims for digital assessments with dates of service on or after May 12, 2023, using HCPCS code G0071.
Use the following CPT codes for billing digital assessments provided from March 1, 2020 – May 11, 2023:
- 99421 (5-10 minutes over a 7-day period)
- 99422 (11-20 minutes over a 7-day period)
- 99423 (21 minutes or more over a 7-day period)
You must submit an RHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services to get paid for the digital assessment service or virtual communication services (HCPCS codes G2012 and G2010).
See Virtual Communication Services FAQs.
- CY 2023 Physician Fee Schedule Final Rule Effective January 1, 2023
-
See below for a list of policies affecting RHCs in the CY 2023 Medicare Physician Fee Schedule Final Rule.
- Added new care management codes for chronic pain management and general behavioral health integration
- Finalized conforming technical changes to the in-person requirements for mental health visits
- Clarified specified provider-based RHC payment-limit per-visit
- Revised HCPCS codes to show the Consolidated Appropriations Act (CAA) CY 2023 Payment Rate:
- G0511: $77.94
- G0512: $146.73
- G0071: $23.72 (1/1/2023 - 5/11/2023); $13.22 (5/12/2023 - 12/31/2023)
- G2025: $98.27
Read the CY 2023 Medicare Physician Fee Schedule Final Rule fact sheet.
- Care Management Services
-
Starting January 1, 2023, care management services provided in RHCs include:
- Transitional care management (TCM)
- Chronic care management (CCM)
- Principal care management (PCM)
- Chronic pain management (CPM)
- General behavioral health integration (BHI)
We pay CCM services at the average of the national non-facility PFS payment rates, either alone or with other payable services, using general care management HCPCS code G0511. We update this rate annually. You must provide at least 20 minutes of qualifying CCM services in a calendar month to bill for this service.
RHCs and FQHCs can bill TCM services and general care management services provided for the same patient during the same service period if the RHC and FQHC meet the requirements for billing each code.
We pay psychiatric collaborative care model (CoCM) services at the average of the national non-facility PFS payment rate, either alone or with other payable services, using HCPCS code G0512. We update this rate annually. You must provide at least 70 minutes of psychiatric CoCM services in the first calendar month, and at least 60 minutes in subsequent calendar months to bill for this service.
For questions on RHC payment policy issues, email RHC@cms.hhs.gov.
-
