Medicare Coverage of Preventive Services Provided in the RHC Setting

Updated Information: In early August, CMS clarified the G0101 & G0102 as a standalone RHC billable service. More information may be found on the CMS website by clicking here.

Background Information: Since 2011, Medicare has been covering certain preventive services. In most instances the co-pay and deductible are waived as long as the patients and providers adhere to the frequency scheduled established for that particular preventive service. This expansion occurred as a result of changes mandated by enactment of the Affordable Care Act.

Services such as Cervical or Vaginal Cancer screening; pelvic and breast examinations; and, screening pap smears have been covered as "stand-alone" services and billable as RHC visits in accordance with CMS published policy (see links below).

http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/screening-pelvic-examinations.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1039.pdf

Recently, CMS announced that these services are no longer considered "medically necessary" face-to-face visits when performed in an RHC or FQHC and therefore not billable as stand-alone services.

MARHC will continue to keep its members aprised of the situation and efforts to change this new policy.