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
- CY 2017 Payment Rate Increase for RHCs. See MM9829 [PDF, 43KB]
- Medicare Benefit Policy Internet Only Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 258KB]
- 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 – Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
- Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers [PDF, 241KB]
- Chapter 29-(T12) -- Independent Rural Health Clinic and Freestanding Federally Qualified Health Center cost Report Form CMS 222-92 (Instructions) [ZIP, 358KB]
- SE1606 - 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)
Enrollment/Certification
- 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
- Survey & Certification - General Information
- Policy & Memos to States and Regions
Conditions for Coverage/Participation
- Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- CfC and CoP: Rural Health Clinic/Federally Qualified Health Center
Legislation
- Social Security Act, Title XVIII, Section 1861(aa) - Opens in a new window - Rural Health Clinic Services and Federally Qualified Health Center Services
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
- 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 Assistance Center - Opens in a new window
- National Center for Frontier Communities - Opens in a new window
- 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 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
- Manuals
- Internet-Only Manuals (IOMs)
- Transmittals
- State Medicaid Manual Paper-Based Manual
Coverage
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Contacts
- CMS Regional Office Rural Health Coordinators - Updated August 2016 [PDF, 98KB]
- Medicare Certified Rural Health Clinics (updated 10-28-16) [PDF, 2MB] This report is sorted by region, by state, and then by provider
- CMS Regional Survey and Certification Contacts [PDF, 19KB]
- CMS Regional Offices and HHS Regions - Map [PDF, 96KB]
Educational Resources
Resources
- 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 Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Rural Health Open Door Forum
- Press Releases - Opens in a new window
- To receive changes to the CMS Quarterly Provider Update, subscribe from the