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RHCs HCPCS Code Billing – New Modifier

RHCs HCPCS Code Billing – New Modifier

For dates of service that began on April 1, 2016 until September 30, 2016, CMS required RHCs to report the appropriate HCPCS code for each service line along with revenue code on their Medicare claims. To receive an all-inclusive rate (AIR) payment, RHCs had to report a visit from the CMS Qualifying Visit List. Visits that contained only HCPCS listed in this document in red italics, RHCs were required to hold the entire claim until October 1. However, if the claim included any other separately payable HCPCS code with one of the red codes, the claim could have been submitted for payment.

Claims that have been held since April 1 may now be released. To prompt the AIR payment, add modifier -CG to the visit code reported with revenue code 052X and/or 0900. The total charges that will be used to calculate the patient’s financial responsibility are also on this line item. It is important to bill these claims as soon as possible to avoid any timely filing issues.

For more information please review the CMS Qualifying Visit List.