- PrEP for HIV
Starting September 30, 2024, CMS covers Pre-exposure Prophylaxis (PrEP) using antiretroviral drugs and other related services to prevent HIV. Visit PrEP for HIV & Related Preventive Services.
- End of the COVID-19 Public Health Emergency (PHE)
The COVID-19 PHE ended on May 11, 2023. View RHCs and FQHCs: CMS Flexibilities to Fight COVID-19 for information about the changes to the RHC and FQHC flexibilities.
COVID-19 Vaccines & Billing
Get information about how to bill for COVID-19 vaccines.
Virtual Communication Services & Digital Assessment Services
Starting May 12, 2023, digital assessment services are no longer included in virtual communication services.
Don’t submit claims for digital assessments with dates of service on or after May 12, 2023, using HCPCS code G0071.
Use the following CPT codes for billing digital assessments provided from March 1, 2020 – May 11, 2023:
- 99421 (5-10 minutes over a 7-day period)
- 99422 (11-20 minutes over a 7-day period)
- 99423 (21 minutes or more over a 7-day period)
You must submit an RHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services to get paid for the digital assessment service or virtual communication services (HCPCS codes G2012 and G2010).
See Virtual Communication Services FAQs (PDF).
- CY 2025 Physician Fee Schedule (PFS) Final Rule Effective January 1, 2025
See below for highlights of payment policies affecting (RHCs/FQHCs) in the CY 2025 Medicare PFS Final Rule.
- Finalized reporting of individual CPT/HCPCS codes for care coordination services, including add-on codes associated with these services and payment at the national non-facility payment rate when the service is furnished either alone or with other payable services .
- Finalized the coding and policies that align with the PFS for Advanced Primary Care Management (APCM) services.
- Finalized a 4 or more services payment rate for IOP services. The IOP payment rate for 3 services is $269.19 and the IOP payment rate for 4 or more services is $408.55.
- Finalized the removal of productivity standards for RHCs effective for cost reporting periods ending after December 31, 2024.
- Clarified that RHCs/FQHCs can furnish dental services that align with the policies and operational requirements in the physician setting, and be paid at the RHC AIR/FQHC PPS, even when furnished on the same day as a medical visit.
- Finalized to continue to allow direct supervision via interactive audio and video telecommunications and to extend the definition of “immediate availability” as including real-time audio and visual interactive telecommunications (excluding audio-only) through December 31, 2025.
- Finalized to allow payment, on a temporary basis, for non-behavioral health visits furnished via telecommunication technology under the methodology that has been in place for these services during and after the COVID-19 PHE through December 31, 2024; RHCs and FQHCs can continue to bill for RHC and FQHC services furnished using telecommunication technology by reporting HCPCS code G2025.
- Finalized to delay the in-person visit requirement for mental health services furnished via communication technology by RHCs and FQHCs to beneficiaries in their homes until January 1, 2026.
- Rebased and revised the FQHC market basket to reflect a 2022 base year. The CY 2025 productivity-adjusted FQHC market basket update is 3.4 percent.
- Beginning January 1, 2025, hepatitis B vaccines and their administration will be paid at 100% of reasonable cost in RHCs and FQHCs, like pneumococcal, flu and COVID-19 vaccines.
- Beginning July 1, 2025, RHCs and FQHCs can bill and be paid for Part B preventive vaccines (pneumococcal, flu, hepatitis B and COVID-19) and their administration at the time of service. Payments will be annually reconciled with the facilities’ vaccine costs on their cost reports.
- Care Coordination Services
Starting January 1, 2025, care coordination services (previously care management services) provided in RHCs/FQHCs will include Advanced Primary Care Management Services (APCM) in the suites of care coordination services as well as Transitional care management (TCM), Chronic care management (CCM), Principal care management (PCM), Chronic pain management (CPM), General behavioral health integration (BHI), Remote physiologic monitoring (RPM), Remote therapeutic monitoring (RTM), Community Health Integration (CHI), Principal Illness Navigation (PIN) and Principal Illness Navigation Peer-Support (PIN-PS).
RHCs/FQHCs will report the individual CPT/HCPCS base codes and add-on codes for each of the care coordination services which will replace HCPCS code G0511. These services will be paid at the national non-facility PFS payment rates.
For those RHCs and FQHCs that need additional time to update their billing systems, they may continue to bill G0511 until July 1, 2025. For those that are ready, you may bill the individual HCPCS codes starting January 1, 2025. RHCs/FQHCs should do one or the other on a facility basis.
- Payment Rates
• List of RHC/FQHC CY 2025 Payment Rates for Care Coordination (ZIP)
Effective March 9, 2024 through December 31, 2024, the payment rates are:
- G0511: $72.90
- G0512: $146.47
- G0071: $13.32
- G2025: $96.87
