Medicare Claims Processing Manual (Pub. 100-04), Ch. 16 § 40.5
Rural Health Clinic (RHC) Billing
40.5 - Rural Health Clinic (RHC) Billing
(Rev. 1, 10-01-03)
B3-3628
For independent RHCs, laboratory services provided in the RHC’s laboratory are not included in the all-
inclusive rate payment to the RHC and may be billed separately to the A/B MAC (B). This includes the six
basic laboratory tests required for certification as well as any other laboratory tests provided in the RHC
laboratory.
Note: If the RHC sends laboratory services to an outside laboratory, the outside laboratory bills the A/B MAC
(B) for the tests.
If the RHC laboratory becomes certified as a clinical laboratory, it bills all laboratory tests performed in its
laboratory to the laboratory’s A/B MAC (B). Laboratory tests are not included as RHC costs nor as part of the
RHC all-inclusive rate payment.
For provider based RHCs the rules in the preceding paragraph apply with the following exception. The
provider bills tests provided in its laboratory to the A/B MAC (A).