Rural Health Clinics and Federally Qualified Health Centers (Rev. 4225,

20.4.1 - Rural Health Clinics and Federally Qualified Health Centers (Rev. 4225, Issues: 02-01-19, Effective: 07-01-19, Implementation: 07-01-19) A. Provider-Based RHC & FQHC - Technical Component The technical component of a screening or diagnostic mammography is outside the scope of the RHC/FQHC benefit. In a provider-based RHC or FQHC, the technical component is billed by the base provider to the A/B MAC (A) under bill type 12X, 13X, 22X, 23X or 85X as appropriate using the base provider’s outpatient provider number (not the RHC/FQHC provider number). The revenue code for a screening mammography is 0403, and the HCPCS code is 77067*, (G0202)*). The revenue code for a diagnostic mammography is 0401, and the HCPCS codes are 77065* (G0206*), 77066* (G0204*). Payment is based on the payment method for the base provider. **G0236 is a deleted code after December 31, 2003. Use 76082* for claims with dates of service January 1, 2004 through December 31, 2006, and code 77051 for claims with dates of service January 1, 2007 and later. * For claims with dates of service January 1, 2017 through December 31, 2017, report CPT codes G0206, G0204, and G0202. For claims with dates of service January 1, 2018 and later, report CPT codes 77065, 77066, and 77067respectively. B. Independent RHCs and Freestanding FQHCs - Technical Component The technical component of a screening or diagnostic mammography is outside the scope of the RHC/FQHC benefit. The practitioner that renders the technical service bills their A/B MACs (B) using Form CMS-1500. Payment is based on the MPFS national non- facility rate. C. Provider-Based RHC & FQHC, Independent RHCs and Freestanding FQHCs - Professional Component The professional component of a screening or diagnostic mammography is within the scope of the RHC/FQHC benefit and is billed under the RHC AIR or the FQHC PPS payment methodology with revenue code 052X. A/B MACs (A) should assure payment is not made for revenue code 0403 (screening mammography) or 0401 (diagnostic mammography). No payment is made on the line item reporting revenue code 0403. For claims with dates of service on or after April 1, 2005, RHCs and FQHCs bill the A/B MAC (A) under bill type 71X or 77X for the professional component of a diagnostic mammography. No payment is made for the professional component of a diagnostic mammography unless there is a qualifying visit on the same day. The services should be billed with the appropriate revenue code. HCPCS coding is required for the diagnostic mammography.