Rural Health Clinic (RHC) Payment Limits

Rural Health Clinic (RHC) Payment Limits - Updates

Effective January 1, 2021, the RHC payment limit per visit for Calendar Year (CY) 2021 is $87.52. This payment limit applies to independent RHCs and RHCs that are provider-based to a hospital with 50 or more beds.

Beginning April 1, 2021, the RHCs will begin to receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021, through 2028.

Then, in subsequent years, the limit is updated by the percentage increase in MEI applicable to primary care services furnished as of the first day of that year.

The RHC payment limit per visit over an 8-year period is as follows,

In 2021, after March 31, at $100 per visit
In 2022, at $113 per visit
In 2023, at $126 per visit
In 2024, at $139 per visit
In 2025, at $152 per visit
In 2026, at $165 per visit
In 2027, at $178 per visit
In 2028, at $190 per visit

Usage of CPT Index - Instructions

The alphabetic index is not a substitute for the main text of the CPT codebook. Even if only one code is present, the coder must refer to the main term to ensure that the code is selected accurately and correctly to identify the services rendered. Main Terms The index is organized by main terms. Each main term can stand alone or can be followed by up to three modifying terms. There are four primary classes of main entries, Procedures or Services - E.g, Scopic, Anastomosis, Splint, Opening Organ or Other Anatomical Site - E.g, Knee, Arm, Ear, Tibia, Colon Conditions - E.g, Abscess, Entropion, Tetralogy of Fallot. Synonyms, Eponyms, and Abbreviations. - ECG, EEG, PET, Brock Operations, Clagett Procdures Modifying Terms The main term may be followed by up to three indented terms that modify the terms they follow. EG. The main term "Endoscopy" is subdivided by the anatomical sites in which the procedure is used. And within these anatomical sites, the specific purpose of the pr

Additional Information About Modifiers

Sequencing of modifiers How can that be if the modifiers used were accurate? There is an order to reporting modifiers and there are three categories that modifier usage fall under: 1. Pricing Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers. The only exception to this rule is when a global surgery package is involved. For example, you would code modifier 58 first and modifier 82 second in a global surgery. A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6. 2. Payment Payment modifiers alert the insurance carrier that there is a special situation within the claim Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78. 3. Location Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9. The general order of sequencing modifiers is ( 1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”. If you code

Evaluation and Management (E/M) Services - Domiciliary or Rest Home Environment

Domiciliary, Rest Home, or Custodial Care Services CPT codes 99324 - 99337 Domiciliary, Rest Home (e.g. Boarding Home), or Custodial Care Services, are used to report E/M services to individuals residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component. A home or domiciliary visit includes a patient History, Physical Examination and Medical Decision Making in various levels depending upon a patient’s needs and diagnosis. The visits may also be performed as counseling and/or coordination of car, when medically necessary outside the office environment and are an integral part of a continuous of the patient's care. The patients seen may have chronic conditions, may be disabled, either physically or mentally, making access to a traditional office visit very difficult, or may have l

Medical Coding Rights

Search This Blog