Part B Coinsurance

40.2 - Part B Coinsurance (Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25) After any applicable deductibles have been satisfied, RHCs paid under the AIR system will be paid 80 percent of their AIR. The patient is responsible for a coinsurance amount of 20 percent of the charges after deduction of the deductible, where applicable. Effective for dates of service on or after January 1, 2011, coinsurance is not applicable for certain preventive services. See section 70 of this manual for information on how to bill for preventive services on a RHC and FQHC claims. FQHCs paid under the PPS will be paid 80 percent of the lesser of the FQHC actual charge for the specific payment code or the adjusted PPS rate. The patient is responsible for a coinsurance amount of 20 percent of the lesser of the FQHCs actual charge for the specific payment code or the adjusted PPS rate. See section 60.2 for more information on the FQHC specific payment codes.