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As many RHC providers can attest, it feels like they are the ugly stepchildren of CMS at times. Many Medicare benefits were not payable in the past to an RHC provider. CMS has implemented some needed changes effective January 1, 2022

Prior to the new statutory payment limit if you were an independent RHC or a provider based RHC with 50+ beds you were reimbursed less than non-capped, provider based RHCS at a rate of $87.52. CMS new payment limit effective April 1, 2021, in which it increased to $100 per encounter. Effective January 1, 2022 this payment has been raised to $113.00. This may not seem like a huge increase but between the change and 2028 they will receive increases each year. While many still don’t think the payment amount is ample, it is the first time in years, they have increased the rate and will continue to increase it for the next 6 years!  It is good to see CMS recognizing the work that rural providers do and what a value they are to their communities.

Another great change for RHCs is they are now able to bill TCM (Transitional Care Management) codes along with General Care Management. In an RHC setting this means you can report TCM along with CCM (Chronic Care Management), General Behavioral Health Integration (BHI) or Principal Care Management (PCM) in addition to the TCM codes. Also, for care management services, keep in mind, some care management codes do not require a face-to-face and auxiliary staff may provide them under general supervision. A face to face is still required for TCM but can be provided via telehealth. Another win for RHCs.

RHC providers are also now allowed to care for hospice patients at hospice facilities. Hospice is now an allowed location in which an RHC visit can take place. Previously these were not allowed, and providers had to seek payment for these services independently, apart from the RHC, under their own Part B provider number. This resulted in lost revenue for some RHC providers. Hospice patients in rural areas will now be able to get much needed care in areas that were in Health Professional Shortage Areas. CMS has also added that RHCs are now eligible to also receive payment for hospice attending physician services when provided by an RHC physician, NP, PA that is employed or working under contract for the RHC.

During the beginning of the pandemic, it was rough going on RHCs is they were only allowed to utilize G0071 for virtual check ins which was not adequate. It is good to see that CMS is recognizing the value of RHC providers and the greater impact their services have on Medicare and Medicaid beneficiaries across the rural areas of the country.



MLN006398 - Rural Health Clinic (

Betsy Rios, CPC

Written by Betsy Rios, CPC

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