(Medicare Benefit Policy Manual)

Coinsurance for psychiatric CoCM services is 20 percent of the lesser of submitted charges or the payment rate for G0512.  Psychiatric CoCM costs are reported in the non-reimbursable section of the cost report and are not used in determining the RHC AIR or the FQHC PPS rate.  G0512 can be billed once per month per beneficiary when all requirements have been met.   Only services furnished by an RHC or FQHC practitioner or auxiliary personnel that are within the scope of service elements can be counted toward the minimum 60 minutes that is required to bill for psychiatric CoCM services and does not include administrative activities such as transc ription or translation services.    240  Virtual Communication Services  (Rev. 252, Issued: 12-07-18, Effective: 01-01-19, Implementation: 01- 02 -19)  Virtual communication services are RHC and FQHC services and include communications-based technology and remote evaluation services.  The RHC and FQHC face-to-face requirements are waived when these services are furnished to an RHC or FQHC patient.   Effec tive January 1, 2019, RHCs and FQHCs receive an additional payment for the costs of communication technology- based services or remote evaluation services that are not already captured in the RHC AIR or the FQHC PPS payment when the requirements for these s ervices are met.  Coinsurance and deductibles apply to RHC claims, and coinsurance applies to FQHC claims for these services.  Requirements   The following requirements must be met for RHCs and FQHCs to bill for virtual communication services:   At least 5 minutes of communications-based technology or remote evaluation services are furnished by an RHC or FQHC practitioner to a patient that has had a billable visit in the RHC or FQHC within the previous year; and   The medical discussion or remote evaluation is  for a condition not related to an RHC or FQHC service provided within the previous 7 days, and does not lead to an RHC or FQHC service within the next 24 hours or at the soonest available appointment.  If the discussion between the patient and the RHC or FQHC practitioner is related to a billable visit furnished by the RHC or FQHC within the previous 7 days or within the next 24 hours or at the soonest available appointment, the cost of the RHC or FQHC practitioners time would be included in the RHC AIR or the FQHC PPS payment and is not separately billable.   Payment for Virtual Communication Services  Virtual communication services furnished by RHCs and FQHCs on or after January 1, 2019, are paid at the  average of the national non- facility PFS payment rate for HCPCS code G2012 (communication technology -based services), and HCPCS code G2010 (remote evaluation services), when the virtual communication HCPCS code, G0071, is on an RHC or FQHC claim, either alone or with other payable services. The payment rate for HCPCS code G0071 is updated annually based on the PFS amounts for these codes.     Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R11803BP  01/26/2023  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update 02/27/2023  13063  R10729BP  04/26/2021  Updates to Medicare Benefit Policy Manual for Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services (Manual Updates Only)  05/26/2021  12252   12/20/2019  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update 01/23/2020  11575  R252BP  12/07/2018  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update 01/02/2019  11019  R239BP  01/09/2018  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update 01/22/2018  10350  R238BP  11/17/2017  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update  02/15/2018  10350  R230BP  12/09/2016  Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Updates  03/09/2016  9864 R220BP  01/15/2016  Rural Health Clinic and Federally Qualified Health Center - Medicare Benefit Policy Manual Update 02/01/2016  9442 R217BP  12/31/2015  Rural Health Clinic and Federally Qualified Health Center - Medicare Benefit Policy Manual Update  Rescinded and replaced by Transmittal 220 02/01/2016  9442 R201BP  12/12/2014  Medicare Benefit Policy Manual - RHC and FQHC Update - Chapter 13 01/05/2015  8981 R173BP  11/22/2013  Medicare Benefit Policy Manual - RHC and FQHC Update - Chapter 13 01/06/2014  8504 R166BP  01/31/2013  Reorganization of Chapter 13 03/01/2013  7824 R114BP  10/30/2009  Outpatient Mental Health Treatment Limitation  01/04/2010  6686 R49BP  03/31/2006  Payment of Federally Qualified Health Centers (FQHCs) for Diabetes Self- Management Training Services (DSMT) and Medical Nutrition Therapy (MNT) Services  06/29/2006  4385 R40BP  11/18/2005  Skilled Nursing Facility Prospective Payment System  02/16/2006  4079 R1BP  10/01/2003  Introduction to the Benefit Policy Manual N/A N/A Back to top of Chapter