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Rural Health Clinics Center

Spotlights

  • 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.
  • Section 1861(aa)(1)(C) of the Social Security Act authorizes RHCs located in areas with a shortage of home health agencies to furnish part-time or intermittent nursing care and related medical supplies (other than drugs and biologicals) by a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) to a homebound individual under a written plan of treatment. The current evaluation and management codes for home health visits are not billable by RNs or LPNs furnishing RHC home health visits. Beginning with dates of service on or after October 1, 2016, RHCs should bill HCPCS code G0490 for these visits. HCPCS code G0490 will be paid as a visit when reported on a RHC claim with revenue code 052X and modifier CG.2016 Update - Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 258KB]
  • Chronic Care Management (CCM) Services for RHCS and FQHCs MLN Matters Article and CCM FAQs.
  • Effective January 1, 2016, Advanced Care Planning (ACP) (CPT code 99497) is a stand-alone billable visit in a RHC.  See billing examples Sample Billing for ACP furnished by RHCs [PDF, 228KB] .
  • 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.

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