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Last Modified: 11/14/2017 Location: FL, PR, USVI Business: Part A

Care coordination services and payment for RHCs and FQHCs

Effective date: January 1, 2018
Implementation date: January 2, 2018


Change request (CR) 10175 provides instructions for payment to rural health clinics (RHCs) billing under the all-inclusive rate, and federally qualified health centers (FQHCs) billing under the prospective payment system, for care coordination services for dates of service on or after January 1, 2018.
Effective January 1, 2016, chronic care management (CCM) payment to RHCs and FQHCs is based on the Medicare physician fee schedule (PFS) national non-facility payment rate when CPT® code 99490 is billed alone or with other payable services on a RHC or FQHC claim. The rate is updated annually and there is no geographic adjustment. Revisions to the CCM requirements for RHCs and FQHCs were in the CY 2017 PFS final rule for services furnished on or after January 1, 2017.
More details, including use of the new codes, are available in MLN Matters® article MM10175 external pdf file.
Source: MM10175
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