Rural Health Clinics (RHCs) Reporting Requirements

Effective April 1, 2016, RHCs are required to report a HCPCS code for each service furnished along with an appropriate revenue code. For claims with dates of service on or after April 1, 2016, RHCs should follow the reporting requirements for modifier CG found in MLN Matters Article SE1611.

The top five reasons RHC claims return to provider (RTP) for correction are:

1. Modifier CG Used More Than Once Per Day
2. Invalid HCPCS
3. Qualifying Visit HCPCS Does Not Meet Policy Requirements
4. Improper Use of Modifier 59 or 25
5. Line Rejected For Invalid Revenue Codes For 071X Type of Bill (TOB)

CMS provides a compilation of Frequently Asked Questions (FAQs) in regards to reporting modifier CG. 

RHCs may refer to the following references for additional guidance:

• Special Edition Article (SE1611) Rural Health Clinics (RHCs) Healthcare Common Procedure Coding System (HCPCS) Reporting Requirement and Billing Updates (PDF)
• Rural Health Clinics Reporting Requirements Frequently Asked Questions (PDF)
• MLN Matters Article MM9269 - Required Billing Updates for Rural Health Clinics (PDF)
• Rural Health Clinic Qualifying Visit List (RHC QVL) (PDF)