Rural Health Clinic: Non-Rural Health Clinic Services, Laboratory Services and Technical Component Services
Certain services are not considered RHC services because either they are:
- Not included in the RHC benefit or
- Not a Medicare benefit
Non-RHC services include, but are not limited to:
- Medicare excluded services
- Routine physical checkups
- Dental care
- Hearing tests
- Routine eye exams, etc.
- Durable medical equipment (DME)
- Ambulance services
- Prosthetic devices
- Body braces (including replacements)
- Practitioner services at certain other Medicare facilities (services furnished to inpatients or outpatients in a hospital (including CAHs), ambulatory surgical center, comprehensive outpatient rehabilitation facility or other facilities whose requirements preclude RHC services).
Note: Covered services provided to a Medicare beneficiary by a RHC practitioner in a skilled nursing facility (SNF) may be a RHC service.
- Telehealth distant-site services
- Hospice services
- Group services (group or mass information programs, health education classes)
Laboratory Services
RHCs must furnish the following lab services to be approved as an RHC. However, these and other lab services are not included in the encounter rate and must be billed separately to Part B on a 1500 claim form.
- Chemical examinations of urine by stick or tablet method or both
- Hemoglobin or hematocrit
- Blood sugar
- Examination of stool specimens for occult blood
- Pregnancy tests
- Primary culturing for transmittal to a certified laboratory (no CPT code available)
Note: When clinics and centers separately bill laboratory services, the cost of the space, equipment, supplies, facility overhead and personnel must be adjusted out of the RHC cost report. This does not include venipuncture, which is included in the all-inclusive rate when furnished in a RHC by a RHC practitioner or furnished incident to a RHC service.
Technical Component Services
For services that can be split into professional and technical components, RHCs bill the technical component to the B/MAC. The professional component is billed to the A/MAC.
Free-Standing Rural Health Clinic
Free standing RHCs bill all laboratory services and technical components on the Part B 1500 claim form or electronic equivalent.
HCPCS codes are required for lab services.
Venipuncture is included in the AIR and is not separately billable.
Payment is made under the fee schedule.
Provider-Based Rural Health Clinic
Provider based RHCs bill all laboratory services and technical components under the host provider's provider number and bill type on the Part A UB-04 claim form or electronic equivalent.
HCPCS codes are required for lab services.
Venipuncture is included in the AIR and is not separately billable.
Payment is made under the fee schedule.
References
- Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-02, Benefit Policy Manual, Chapter 13
- CMS IOM Publication 100-02, Benefit Policy Manual, Chapter 16
- CMS IOM Publication 100-04, Claims Processing Manual, Chapter 9
- CMS IOM Publication 100-04, Claims Processing Manual, Chapter 17