You should report modifier CG on one line with a
medical and/or a mental health HCPCS code that
represents the primary reason for the medically necessary face-to-face visit.
RHCs should report modifier CG on one line with a medical and/or mental healthHCPCS code that represents the primary reason for the medically necessary face-to-face visit. This line should have the bundled charges for all services that are subject to coinsurance and the deductible (e.g., charges for all services furnished during the visit minus the charges for preventive services for which the coinsurance and/or deductible are waived).If only preventive services are furnished during the visit, the RHC should report modifier CG with the preventive HCPCS code that represents the primary reason for the medically necessary face-to-face visit and the bundled charges.
Should modifier CG be reported if only preventive services are furnished during the visit?
Yes. If only preventive services for which the coinsurance and/or deductible arewaived are furnished during the visit, the RHC should report modifier CG with thepreventive HCPCS code that represents the primary reason for the visit and the bundledcharges.
If a medical service and a preventive service are furnished on the same day, should modifierCG be reported with both services?
No. Modifier CG should be reported only with the medical service HCPCS code thatrepresents the primary reason for the medically necessary face-to-face visit when medicaland preventive services are furnished on the same day.
Is there a list of services that qualify as stand-alone billable visits or will any service be paidas long as modifier CG is reported?
To assist RHCs when HCPCS codes were first required to be on all claims, we posteda qualifying visit list to serve as a guide to services that generally qualify as stand-alonebillable visits. The HCPCS reporting requirements have not changed what is considered aRHC stand-alone billable visit, which is typically evaluation and management type ofservices or screenings for certain preventive services. We will monitor claims over thenext several months to determine if the modifier is used appropriately, and will considermodifications to the payment system if necessary.
Should RHCs report modifier CG for services furnished incident to a billable visit?
No, incident to services are listed on the claims with a charge greater than or equalto $0.01 and without modifier CG.
Where can I get additional information?
The CMS RHC Center Page
https://www.cms.gov/center/provider-type/rural-health-clinics-center