From: CMS MLN Articles – MM9442 – 12/31/15
New Information Includes:
- Section 30.1 states that a RHC can count the time of a nurse practitioner (NP), physician assistant (PA), or certified nurse midwife (CNM) when furnishing direct patient care in a patient’s home or another location towards the requirement that an NP, PA, or CNM be available to furnish care at least 50 percent of the time the RHC is open to provide patient care.
- Section 110.5 states that payment for chronic care management (CCM) services is authorized for RHCs and FQHCs beginning on January 1, 2016, and provides an overview of the requirements.
- Sections 220.1 and 220.3 state that lung cancer screening using low-dose computed tomography is a covered preventive service and can be billed as a stand-alone visit if it is the only service furnished on that day with a RHC or FQHC practitioner, and applicable coinsurance and deductibles are waived.
Clarifying Information Includes:
- Use of Modifier 59 (Section 40.3)
- Payment for procedures (Section 40.4)
- Description of ambulance services that are non-covered (Section 60.1)
- Description of group services that are non-covered (Section 60.1)
- Information on payment codes for FQHCs (Section 70.4)
- Cost reporting requirements (Section 80.1 and 80.2)
- Billable visits by dentists, podiatrist, optometrists, and chiropractors (Section 110.1)
- Description of mental health visits, billing for mental health visits, and payment for medication management (Section 170)
- Hepatitis C screening in RHCs and FQHCs (Sections 220.1 and 220.2).