CPT 99082 - Paymnet guide - Rural health clinic

 Rural Health Clinic and Federally Qualified Health Center Services

Payment may be made under Part B for the medical and other health services furnished by a qualified rural health clinic (RHC) and Federally qualified health centers (FQHCs). The covered services RHCs/FQHCs may offer are divided into two basic groups: RHC/FQHC services (defined below) and other medical and other health services covered under Part B.

Items and services which meet the definition of RHC services or FQHC services are reimbursed either by designated RHC intermediaries, or a national FQHC FI in the case of independent RHCs/FQHCs, or by the provider’s FI in the case of provider based clinics. In either case, the carrier does not pay claims for services defined as RHC/FQHC services. The FI pays for such services through a prospectively determined encounter rate.

Where an RHC or a FQHC is approved for billing other medical and health services to the carrier, the RHC or FQHC bills the carrier and is paid according to the method of payment for the service provided.

Rural health clinic and Federally qualified health center services are described in the Medicare Benefit Policy Manual, Chapter 13. That chapter provides that the following

services usually performed by physicians are included as services included in the encounter rate and therefore are not separately billable for RHC/FQHC patients. They are:

*Professional services performed by a physician for a patient including diagnosis, therapy, surgery, and consultation (See the Medicare Benefit Policy Manual, Chapter 15);

*Services and supplies incident to a physician’s services, as described in the Benefit Policy Manual, Chapter 15;

*Nurse practitioner and physician assistant services (including the services of specialized nurse practitioners and nurse midwives) that would be covered if furnished by a physician, provided the nurse practitioner or physician assistant is legally permitted to perform the services by the State in which they are performed;

*Services and supplies incident to the services of nurse practitioners and physician assistants that would be covered if furnished incident to a physician’s services, and

*Visiting nurse services to the homebound.

However, the technical component of diagnostic services may be billed separately by the physician to the carrier, if provided. See Chapter 9, and the Medicare Benefit Policy Manual, Chapter 13, for additional information on the definition of RHC/FQHC services.

Also, an RHC or FQHC may provide other items and services which are covered under Part B, but which are not defined as RHC or FQHC services. They are listed in the Medicare Benefit Policy Manual, Chapter 13. Independent RHCs/FQHCs bill the carrier for such services. Provider-based RHC/FQHC services are billed to the FI as services of the parent provider.

Independent RHCs/FQHCs must enroll with the carrier in order to bill.

80.3- Unusual Travel (CPT Code 99082)

In general, travel has been incorporated in the MPFSDB individual fees and is thus not separately payable. Carriers must pay separately for unusual travel (CPT code 99082) only when the physician submits documentation to demonstrate that the travel was very unusual.

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