Resolved Rural Health Clinic Modifier CG

[MistyR_46049]

For RHC office visits 0521-revenue code does the modifier -CG apply, I have read several different things regarding this modifier I have a client that is appending the CG modifier to office visits, CMS I read says it should apply to HCPCS codes for mental health? Just wanted to see if I could get some clarification.

 

[Lori]

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.
This line should have the bundled charges for all services subject to coinsurance and deductible. If only preventive services are furnished during the visit, report modifier CG with the preventive service HCPCS code that represents the primary reason for the medically necessary face-to-face visit.

Medical and preventive services HCPCS codes are billed with revenue code 052X.
Mental health services HCPCS codes are billed with revenue code 0900.

Reporting Requirement - Modifier CG

www.novitas-solutions.com

RHC Revenue Codes CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 50

RHC services must be billed with the below RHC revenue codes and a Healthcare Current Procedural Coding System (HCPCS) code descripting the encounter: 0521 - Clinic Visit by member to RHC 0522 - Home visit by RHC practitioner 0524 - Visit by RHC practitioner to a member in a covered Part A stay at a Skilled Nursing Facility (SNF) 0525 - Visit by RHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility 0527 - RHC Visiting Nurse Service(s) to a member's home when in a Home Health Shortage Area 0523 - Visit by RHC practitioner to other non RHC site (e.g., scene of accident) 0900 - Behavioral Health Treatments/Services

Non-allowed Revenue Codes CMS Medicare Learning Network (MLN) Matters (MM)9269

Effective April 1, 2016, RHCs including RHCs exempt from electronic reporting under §424.32 (d)(3), are required to submit HCPCS and revenue codes. These revenue codes are not allowed. 002x-024x 029x 045x 054x 056x 060x 065x 067x-072x 080x-088x 093x 096x-310x

Visiting Nurse Services CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 13, Section 190

Visiting Nurse Services performed by RN or LPN when a patient is considered homebound. Beginning with dates of service on/after April 1, 2016 Line item date of service Type of bill (TOB) 071X Revenue code 052X Modifier CG HCPCS code G0490 Paid all-inclusive rate (AIR)

RHC Billing Guide - JE Part A - Noridian

The RHC Billing Reference Guide is provided.

med.noridianmedicare.com

 

[MistyR_46049]

So if its an office visit 99214- then if the revenue code is 0521 then the CG can be appended to the office visit

 

[Lori]

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

https://www.cms.gov/medicare/medicare-fee-for-service-payment/fqhcpps/downloads/rhc-reporting-faqs.pdf