Medicare Benefit Policy Manual (Pub. 100-02), Ch. 13 § 70.2.1
Payment Limits Applicable to Independent RHCs,
70.2.1 – Payment Limits Applicable to Independent RHCs,
Provider-Based RHCs in a Hospital with 50 or More Beds, and New
RHCs
(Rev. 11803; Issued: 01-26-23; Effective: 01-01-23; Implementation: 02-27-23)
Beginning April 1, 2021, independent RHCs, provider-based RHCs in a hospital
with 50 or more beds, and RHCs enrolled under Medicare on or after January 1,
2021 will receive a prescribed national statutory payment limit per visit increase
over an 8-year period for each year from 2021 through 2028.
The national statutory payment limit for RHCs over the 8-year period is as follows:
● In 2021, after March 31, at $100 per visit;
● In 2022, at $113 per visit;
● In 2023, at $126 per visit;
● In 2024, at $139 per visit;
● In 2025, at $152 per visit;
● In 2026, at $165 per visit;
● In 2027, at $178 per visit; and
● In 2028, at $190 per visit.
Beginning in 2029 and each year thereafter the limit established for the previous year is
increased by the percentage increase in MEI applicable to primary care services furnished
as of the first day of such year.
We note that new RHCs are those that have submitted an application and are enrolled
under Medicare on or after January 1, 2021.