Hospital-Based Rural Health Clinics and Federally Qualified Health Centers Billing for Non RHC, FQHC Service

Prior to implementation of the Hospital Outpatient Prospective Payment System (OPPS), hospital-based Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were permitted to include both RHC/FQHC and non-RHC/FQHC services on the same claim, under an RHC/FQHC bill type with appropriate revenue codes.

Beginning with the implementation of OPPS, non-RHC/FQHC services provided by a hospital based RHC/FQHC, including RHCs/FQHCs that are parts of Critical Access Hospitals (CAHs) or other exempted or excluded (from OPPS) hospitals, must be billed under the host hospital’s provider number, using hospital billing procedures and bill types. 

Services that are not covered or paid as RHC/FQHC services may instead be covered as hospital outpatient services and paid under the applicable methodology for the hospital. RHC/FQHC services remain subject to the encounter rate payment methodology and are billed using the RHC/FQHC provider number, bill type and revenue codes.

For a description of covered RHC/FQHC services, please review the Medicare Benefit Policy Manual, CMS IOM Pub. 100-02, Chapter 13 ( Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services) (PDF)

Bill Types

• FQHC
  • 77x
• Hospital Based Non-Air (Technical Components) are Hospital Outpatient
  • 13x, 14x and 22x

References

• Medicare Claims Processing Manual, CMS IOM Pub. 100-04, Chapter 4 — Part B Hospital (Including Inpatient Hospital Part B and OPPS), Section 280 (PDF)
• Medicare Claims Processing Manual, CMS IOM Pub. 100-04, Chapter 9 — Rural Health Clinics/ Federally Qualified Health Centers (PDF)