Billing Guidelines for RHCs Claims under the AIR System

60.1 - Billing Guidelines for RHCs Claims under the AIR System (Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25) When billing Medicare, RHCs must report all services provided during the encounter/visit by listing the appropriate revenue and HCPCS code. The additional revenue lines with detailed HCPCS code(s) are for information and data gathering purposes. Encounters with more than one health professional and multiple encounters with the same health professionals that take place on the same day and at a single location generally constitute a single visit. For RHCs, the payment is applied to the service line with revenue code 052X for medical and revenue code 0900 for mental health visits with modifier (MOD) CG. For example: Appropriate Rev Code Appropriate HCPCS code MOD DOS Charges 0521 99213 -Evaluation and Management (E&M) CG 01/01 300.00 Note: The examples in this chapter may vary and are subject to change as needed. Please see section 50 for more information on reporting modifier CG. For example: Appropriate Rev Code Appropriate HCPCS Code MOD DOS Charges 0521 99213 - E&M CG 01/01 300.00 0770 G0402 - Preventive Service (PS) 01/01 50.00 Medicare will make an additional AIR payment for IPPE, when billed on the same day with a qualified encounter/visit. When reporting an additional encounter/visit for IPPE, the RHC reports the Appropriate HCPCS Code for the service. The revenue lines should be reflected as follows: For example: Appropriate Rev Code Appropriate HCPCS code MOD DOS Charges 0521 99213 - E&M CG 01/01 75.00 0419 94640 - Breathing treatment 01/01 75.00 0521 G0402 - Initial Preventive 01/01 150.00 Physical Examination (IPPE) For RHCs, Medicare will make an additional AIR payment for a subsequent illness or injury that occurs on the same day. This is reported on the claim with an additional service line with revenue code 052X, a valid HCPCS code and modifier 59. Please see section 50 for more information on reporting modifier 59. For example: Appropriate Rev Code Appropriate HCPCS code MOD DOS Charges 0521 99213 - E&M CG 01/01 150.00 0479 69209 - Removal of Wax from Ear 01/01 50.00 0521 99212 - OV (Office Visit) 59 01/01 135.00 0272 A6402 - Surgical Dressing 01/01 25.00 0279 29130 - Finger Split 01/01 95.00