evekhm/cms_iom_500 huggingface dataset:
(Medicare Benefit Policy Manual)
 Commonly furnished in an outpatient clinic setting;    Furnished under the direct supervision of an NP, PA, or CNM, except for authorized care management services which may be furnished under general supervision; and   Furnished by a member of the RHC or FQHC staff. NOTE:  The direct  supervision requirement is met in the case of an NP, PA, or CNM who supervises the furnishing of the service only if such a person is permitted to exercise such supervision under the written policies governing the RHC or FQHC.  Services and supplies covered under this provision are generally the same as described in section 120 as incident to a physicians services and include services and supplies incident to the services of an NP, PA, or CNM. 150 - Clinical Psychologist (CP) and Clinical Social Worker (CS W) Services  (Rev. 252, Issued: 12-  07-18, Effective: 01- 01-19, Implementation: 01-  02-19)  A CP is an individual who:   Holds a doctoral degree in psychology, and   Is licensed or certified, on the basis of the doctoral degree in psychology, by the state in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.  A CSW is an individual who:   Possesses a masters or doctors degree in social work;   After obtaining the degree, has performed at least 2 years of supervised clinical social work; and   Is licensed or certified as a clinical social worker by the state in which the services are performed; or, in the case of an individual in a state that doe s not provide for licensure or certification, meets the requirements listed in 410.73(a)(3)(i) and (ii).
(Medicare Benefit Policy Manual)
Services may include diagnosis, treatment, and consultation.  The CP or CSW must directly examine the patient, or directly review the patients medical information.  Except for services that meet the criteria for authorized care management or virtual communication services, telephone or electronic communication between a CP or CSW and a patient, or between such practitioner and someone on behalf of a pa tient, are considered CP or CSW services and are included in an otherwise billable visit.  They do not constitute a separately billable visit.  CSWs are statutorily authorized (1861(hh)(2) of the Act) to furnish services for the diagnosis and treatment of mental illnesses only.   Services that are covered are those that are otherwise covered if furnished by a physician or as incident to a physicians professional service.  Services that a hospital or SNF is required to provide to an inpatient or outpatient as a requirement for participation are not included.   Services performed by CPs and CSWs must be:   Furnished in accordance with RHC or FQHC policies and any physician medical orders for the care and treatment of a patient;   A type of service which the CP or CSW who furnished the service is legally permitted to furnish by the state in which the service is rendered; and   Furnished in accordance with state restrictions as to setting and supervision, including any physician supervision requirements.   160 - Service s and Supplies Incident to CP and CSW Services  (Rev. 252, Issued: 12- 07-18, Effective: 01- 01-19, Implementation: 01-  02-19)  Services and supplies that are integral, though incident to a CP or CSW service are:   Commonly rendered without charge or included in the RHC or FQHC payment;   Commonly furnished in an outpatient clinic setting;   Furnished under the direct supervision of the CP or CSW, except for  authorized care management  services which may be furnished under general supervision; and  Furnished by a member of the RHC or FQHC staff.   NOTE:  The direct supervision requirement is met in the case of a CP or CSW who supervises the furnishing of the service only if such a person is permitted to exercise such supervision under the written policies governing the RHC or FQHC.  Services and supplies covered under this provision are generally the same as described in section 120 as incident to a physicians services and include services and supplies incident to the services of a CP or CSW.
(Medicare Benefit Policy Manual)
170 - Mental Health Visits  (Rev. 11803; Issued: 01-26- 23; Effective: 01 -01-23; Implementation: 02-27-23)
(Medicare Benefit Policy Manual)
A mental health visit is a medically -necessary face -to-face encounter between an RHC or  FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQH C mental health services are rendered.  Effective January 1, 2022, a mental health visit is a face -to-face encounter or an encounter furnished using interactive, real- time, audio and video telecommunications technology or audio -only interactions in cases w here the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder. The CAA, 2023 extends the telehealth policies of the CAA, 2022 through December 31, 2024 if the PHE ends prior to that date .  The in -person visit requirements for mental health telehealth services and mental health visits furnished by RHCs and FQHCs begin on January 1, 2025 if the PHE ends prior to that date. There must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patients medical record. RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real -Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Tel emedicine Service Rendered Via Telephone or Other Real- Time Interactive Audio -Only Telecommunications System) in cases where the service was furnished using audio-only communication. Mental health services that qualify as stand -alone billable visits in an FQHC are listed on the FQHC center website,  http://www.cms.gov/Center/Provider- Type/Federally -Qualified -Health -Centers
(Medicare Benefit Policy Manual)
health services that qualify as stand -alone billable visits in an FQHC are listed on the FQHC center website,  http://www.cms.gov/Center/Provider- Type/Federally -Qualified -Health -Centers -FQHC - Center.html . Services  furnished must be within  the practitioners  state scope of practice.
(Medicare Benefit Policy Manual)
Medicare-covered mental health services furnished incident to an RHC or FQHC visit are  included in the payment for a medically  necessary  mental health  visit when an RHC or  FQHC  practitioner  furnishes  a mental  health  visit.  Group mental  health  services  do not      meet  the criteria  for a  one-one- one, face -to-face encounter  in an FQHC  or RHC.   A mental health service should be reported using a valid HCPCS code for the service furnished, a mental health revenue code, and for FQHCs, an appropriate FQHC mental health  payment code.  For detailed  information  on reporting mental  health  services and  claims processing, see Pub. 100-04, Medicare Claims Processing Manual, chapter 9, http://www.cms.gov/Regulations- and- Guidance/Guidance/Manuals/downloads/clm104c09.pdf   Medication  management, or  a psychotherapy  add  on service,  is not  a separately  billable  service in an RHC or FQHC and is included in the payment of an RHC or FQHC medical  visit.  For example, when a medically -necessary medical visit with an RHC or FQHC  practitioner  is furnished, and on the same day  medication  management or  a psychotherapy add on service is also furnished by the same or a different RHC or FQHC  practitioner,  only one payment  is made for the qualifying medical services  reported  with a medical revenue code.  For FQHCs, an FQHC mental health payment code is not  required for reporting medication management or a psychotherapy add on service  furnished on the  same day  as a medical service.   180 - Physical Therapy, Occupational Therapy, and Speech Language Pathology Services (Rev. 263, Issued: Effective: 01- 01-20, Implementation: 01- 23-20)
(Medicare Benefit Policy Manual)
180 - Physical Therapy, Occupational Therapy, and Speech Language Pathology Services (Rev. 263, Issued: Effective: 01- 01-20, Implementation: 01- 23-20)  Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) services may be provided in the RHC or FQHC directly by a physician, NP, or PA, if included in the practitioners scope of practice.  A physician, NP, or PA may also supe rvise the provision of PT, OT, and SLP services provided incident to their professional services in the RHC or FQHC by a PT, OT, or SLP therapist.  PT, OT, and SLP therapists who provide services incident to a physician, NP, or PA visit may be an employee of the RHC or FQHC or contracted to the RHC or FQHC.  PT, OT, and SLP services furnished by an RHC or FQHC practitioner or furnished incident to a visit with an RHC or FQHC practitioner are not billable visits.  If the services are furnished on a day when no otherwise billable visit has occurred, the PT, OT, or SLP service provided incident to the visit would become part of the cost of operating the RHC or FQHC.  The cost would be included in the costs claimed on the cost report and there would be no billable visit.   190 - Visiting Nursing Services (Rev. 220, Issued: 01- 15-16, Effective: 02- 01-16, Implementation: 02- 01-16)
(Medicare Benefit Policy Manual)
190 - Visiting Nursing Services (Rev. 220, Issued: 01- 15-16, Effective: 02- 01-16, Implementation: 02- 01-16)  190.1 - Description of Visiting Nursing Services  (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18)  A visiting nu rse provides skilled nursing services.  The determination of whether a service requires the skills of a nurse is based on the complexity of the service (e.g., intravenous and intramuscular injections or insertion of catheters), the condition of the patient  (e.g., a non -skilled service that, because of the patients condition, can only be safely and effectively provided by a nurse), and accepted standards of medical and nursing practice.  All services must be reasonable and necessary to the diagnosis and tre atment of the patients illness or injury within the context of the patients unique medical condition.  A service that can be safely and effectively self -administered or performed by a nonmedical person without the direct supervision of a nurse, is not considered a skilled nursing service, even if provided by a nurse. A service which, by its nature, requires the skills of a nurse to be provided safely and effectively continues to be a skilled service even if it is taught to the patient, the patients family , or other caregivers.  If a patient needs skilled nursing care and there is no one trained or able and willing to provide it, the services of a nurse would be reasonable and necessary to the treatment of the illness or injury.  The determination of whether visiting nurse services are reasonable and necessary is made by the physician based on the condition of the patient when the services were ordered and what is reasonably expected to be appropriate treatment for the illness or injury throughout the certifi cation period.  190.2 - Requirements for Furnishing Visiting Nursing Service  (Rev. 252, Issued: 12- 07 -18, Effective: 01-01-19, Implementation: 01- 02-19)
(Medicare Benefit Policy Manual)
190.2 - Requirements for Furnishing Visiting Nursing Service  (Rev. 252, Issued: 12- 07 -18, Effective: 01-01-19, Implementation: 01- 02-19)   RHCs and FQHCs are paid for visiting nursing services when G0490 is on an RHC or FQHC claim and all of the following requirements are met:   The patient is considered confined to the home as defined in section 1835(a) of the Act and the Medicare Benefit Policy Manual, Chapter 7 (see http://www.cms.gov/Regulations -and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf ;   The RHC or FQHC is located in an area that has a shortage of home health  agencies;   The services and supplies are provided under a written plan of treatment;   Nursing services are furnished on a part- time or intermittent basis only; and   Drugs and biological products are not provided.   190.3 - Home Health Agency Shortage Area  (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18)  A shortage of HHAs exists if an RHC or FQHC is currently located in a county, parish or similar geographic area in which the Secretary has determined that:    There is no participating HHA under Medicare, or adequate home health services are not available to RHC or FQHC patients even though a participating HHA is in the area; or   There are patients whose homes are not within the area serviced by a participating HHA; or considering the ar eas climate and terrain, whose homes are not within a reasonable traveling distance to a participating HHA.   190.4 - Authorization for Visiting Nursing Services  (Rev. 220, Issued: 01-15-16, Effective: 02-01-16, Implementation: 02-01-16)   RHCs or FQHCs that are located in an area that has not been determined to have a current HHA shortage and are seeking to provide visiting nurse services must make a written request to the CMS RO along with written justification that the area it serves meets the required  conditions.  190.5 - Treatment Plans  for Visiting Nursing Services  (Rev. 252, Issued: 12- 07 -18, Effective: 01-01-19, Implementation: 01- 02-19)
(Medicare Benefit Policy Manual)
For services and supplies that require a treatment plan, the treatment plan must be written and reviewed by a supervising physician, NP, PA, CNM, or CP, as appropriate, at least once every 60 days; and meet other documentation requirements.  If the patient does not receive at least one covered nursing visit in a 60- day period, the plan is considered terminated for the purpose of Medicare coverage unless:    The supervising physician has reviewed the plan of treatment and made a recertification within the 60- day period which indicates that the lapse of visits is a part of the physicians regimen for the patient, or   Nursing visits are required at intervals less frequently than once every 60 days, but the intervals are predictable (e.g., it is predictable that a visit is required only every 90 days for the purpose of changing a silicone catheter, etc.).   Home nursing visits furnished before the plan is put into writing are covered if authorized in writing by the supervising physician.
(Medicare Benefit Policy Manual)
Home nursing visits furnished before the plan is put into writing are covered if authorized in writing by the supervising physician.   200 - Telehealth Services  (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18)  RHCs and FQHCs may serve as an originating site for telehealth services, which is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs.  RHCs and FQHCs that serve as an originating site for telehealth services ar e paid an originating site facility fee.  Although FQHC services are not subject to the Medicare deductible, the deductible must be applied when an FQHC bills for the telehealth originating site facility fee, since this is not considered an FQHC service.  RHCs and FQHCs are not authorized to serve as a distant site for telehealth consultations, which is the location of the practitioner at the time the telehealth service is furnished, and may not bill or include the cost of a visit on the cost report.  This includes telehealth services that are furnished by an RHC or FQHC practitioner who is employed by or under contract with the RHC or FQHC, or a non -RHC or FQHC practitioner furnishing services through a direct or indirect contract.  For more information on Medicare telehealth services, see Pub. 100 -02, Medicare Benefit Policy Manual, chapter 15, and Pub. 100- 04, Medicare Claims Processing Manual, chapter 12.  210 - Hospice Services  (Rev. 230, Issued: 12- 09-16, Effective: 03- 09-17, Implementation: 03- 09-17)  210.1 - Hospice Attending  Physician Services Payment   (Rev. 11803; Issued: 01- 26-23; Effective: 01 -01-23; Implementation: 02- 27-23)
(Medicare Benefit Policy Manual)
210.1 - Hospice Attending  Physician Services Payment   (Rev. 11803; Issued: 01- 26-23; Effective: 01 -01-23; Implementation: 02- 27-23)  Medicare beneficiaries who elect the Medicare hospice benefit may choose either an  individual physician, NP  or PA to serve as their designated attending practitioner (Section 1861(dd) of  the Act).  Beginning January 1, 2022, under  section 132 of the CAA 2021, RHCs and FQHCs are authorized to serve in this role. A physician , NP, or PA  who works for an RHC or  FQHC may p rovide hospice attending physician services during a time when he/she is working  for the RHC  or FQHC  (unless  prohibited by  their RHC  or FQHC  contract  or employment          agreement).  The RHC or FQHC would bill for these services as they would for any oth er qualified service to be paid the RHC AIR or the FQHC PPS rate, respectively.  A physician, NP, or PA who works for an RHC or FQHC may provide hospice attending services during a time when he/she is not working for the RHC  or FQHC  (unless prohibited by their RHC  or FQHC  contract or employment          agreement).  These services would not be considered RHC or FQHC services  and the physician or NP would bill for these services under regular Part B rules using his/her own  provider number. Any service prov ided to a hospice beneficiary by an RHC or FQHC practitioner must comply with Medicare prohibitions on commingling. (See section 100  of this chapter).      210.2 - Provision of Services to Hospice Patients in an RHC or FQHC  (Rev. 11803; Issued: 01-26-23; Effective: 01 -01-23; Implementation: 02-27-23)
(Medicare Benefit Policy Manual)
210.2 - Provision of Services to Hospice Patients in an RHC or FQHC  (Rev. 11803; Issued: 01-26-23; Effective: 01 -01-23; Implementation: 02-27-23)  For hospice services that are not described above in section 210.1, RHCs and FQHCs can treat hospice beneficiaries for medical conditions not related to  their terminal illness.  However, if a Medicare benefici ary who has elected the hospice benefit receives care from an RHC or FQHC related to his/her terminal illness, the RHC  or FQHC cannot be reimbursed for the visit, even if it is a medically necessary, face- to- face visit with an RHC or FQHC practitioner, since that would result in duplicate payment for services, except  under either  of the following circumstances:   The RHC or FQHC has a contract with the hospice provider to furnish core hospice services related to the patients terminal illness and related conditions when extraordinary circumstances exist within the hospice.  Extraordinary circumstances are described as unanticipated periods of high patient loads; staffing shortages due to illness or other short- term temporary situations that interrupt patie nt care; and temporary travel of a patient outside the hospices  service area ( 42CFR 418.64);   The RHC or FQHC has  a contract with the hospice provider to furnish highly specialized  nursing services that  are provided by the hospice so infrequently that  it would be impractical and prohibitively expensive for the hospice to employ a practitioner to provide these services.  For example, a hospice may infrequently  have a pediatric patient, and in those situations, contract with an RHC or FQHC that has a pediatric  nurse on staff to furnish hospice services  to the patient.  In these situations, all costs associated with  the provision of hospice services must be carved  out of the RHC  or FQHC  cost report,  and the RHC  or FQHC  would be reimbursed  by the hospice.  ( 42 CFR 418.64(b)(3)).  Any service provided to a hospice beneficiary by an RHC or FQHC practitioner must comply with Medicare prohibitions on commingling.  (See section  100 of this chapter).
(Medicare Benefit Policy Manual)
Any service provided to a hospice beneficiary by an RHC or FQHC practitioner must comply with Medicare prohibitions on commingling.  (See section  100 of this chapter).   220 - Preventive Health Services  (Rev. 230, Issued: 12-09-16, Effective: 03-09-17, Implementation: 03-09-17)  RHCs and FQHCs are paid for the professional component of allowable preventive services when all of the program requirements are met and frequency limits (where applicable) have not been exceeded.  The beneficiary copayment and deductible (where applicable) is waived by the Affordable Care Act for the IPPE and AWV, and for Medicare-covered preventive services recommended by the USPSTF with a grade or A or B.    220.1 - Preventive Health Services in RHCs  (Rev. 11803; Issued: 01-26- 23; Effective: 01 -01-23; Implementation: 02-27-23) Influenza  (G0008) , Pneumococcal  (G0009)  and COVID -19 vaccines, and certain COVID -19 monoclonal antibody products  Influenza, pneumococcal and COVID-19 vaccines and covered monoclonal antibody products used as pre-exposure prophylaxis prevention of COVID-19 and their administration are paid at 100 pe rcent of                                           reasonable cost through the cost report. No visit is billed, and these costs should not be included on the claim.  The beneficiary  coinsurance and deductible are waived.   Hepatitis  B Vaccine (G0010)  Hepatitis B vaccine and its administration is included in the RHC visit and is not separately billable.  The cost of the vaccine and its administration can be included in the line item for the otherwise qualifying visit.  A visit cannot be billed if vaccine administration is the only service the RHC provides. The beneficiary coinsurance and  deductible are waived.   Initial Preventive Physical  Exam (G0402)