FQHCs and RHCs Are Now Able to Bill for CCM Services
When CMS introduced the opportunity for providers to bill for CPT code 99490 in January 2015, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were excluded from participating. However, beginning January 2016, FQHCs and RHCs may now participate in the program and receive an additional payment from CMS for the costs of services that are not already captured in the RHC all inclusive rate or the FQHC prospective payment system for chronic care management services to Medicare beneficiaries that qualify to receive such services.
Download our Chronic Care Management eQGuide for a definition of a qualified Medicare beneficiary.
Face-to-Face Requirement Updates for FQHC and RHC
In addition, in the updated ruling FQHC and RHC face-to-face requirements are waived when chronic care management services are furnished to a FQHC or RHC patient. The big news here is that these entities will be given the opportunity to improve the quality of care for their chronically ill patient population, and create a lucrative, new revenue stream.
Calculating CPT Code 99490 Reimbursements for FQHC and RHC
Calculating CPT Code 99490 reimbursements for FQHCs and RHCs, their chronic care management service payments will be based on the Medicare physician fee schedule national average non-facility rate when CPT code 99490 is billed alone or with other payable services on a RHC or FQHC claim. Unlike the geographically adjusted rates for other providers, their rate will be updated annually and has no geographic adjustment.
CPT Code 99490 Coinsurance Applications for FQHC and RHC
Lastly, as with all other providers who bill for CPT Code 99490, coinsurance does apply. Coinsurance would be applied as applicable to FQHC claims, and coinsurance and deductibles would apply as applicable to RHC claims as well.
Applying CPT Code 99490 2016 Updates to Your CCM Program
All of this information may sound a little complicated, but eQHealth Solutions can help any provider or health organization navigate their way to a successful chronic care management program. If you are a FQHC or RHC, download our free Chronic Care Management eQGuide to learn more about what requirements must be met to participate in billing for CPT code 99490.