Billing Medicare as a safety-net provider
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill Medicare for telehealth services during the COVID-19 public health emergency.
Reimbursement policies for RHCs and FQHCs
RHCs and FQHCs can provide services as a distant site provider using telehealth. Any service that Medicare has approved to be furnished via telehealth can be provided by an FQHC or RHC during the COVID-19 public health emergency.
During the COVID-19 public health emergency:
- FQHCs and RHCs can bill Medicare for telehealth services as distant site providers, at a reimbursement rate of $92.03, retroactive to January 27, 2020.
- The patient’s home is an eligible originating site during the COVID-19 public health emergency (as of March 6, 2020).
- Coverage for virtual communication services now includes online digital evaluation and management. For the purposes of billing Medicare, these services are not considered telehealth and are reimbursed at a different rate. See virtual communication billing codes for RHCs and FQHCs for more details.
Telehealth billing codes for RHCs and FQHCs
For FQHC and RHC telehealth services provided on or after July 1, 2020 through the end of the COVID-19 public health emergency, use the following:
CS: required if cost-sharing is waived (e.g., COVID-19 testing related services or preventive services provided via telehealth)
CG: optional (not required on or after July 1, 2020)
Audio-only services (CPT codes 99441, 99442, and 99443) are billable under the new G2025 code.
For the full list of telehealth services, including which services can be provided as audio-only visits, see this list of telehealth services from the Centers for Medicare & Medicaid Services.
Virtual communication billing codes for RHCs and FQHCs
FQHCs and RHCs can bill for digital evaluation and management services during the COVID-19 public health emergency:
- Use HCPCS code G0071 alone or with other payable services when submitting claims for virtual communication services.
- The new payment rate for all claims submitted with code G0071 is $24.76, and covers services delivered on or after March 1, 2020.
- The newly covered online digital evaluation and management CPT codes (e-visits) include:
- 99421 (5-10 minutes over a 7-day period)
- 99422 (11-20 minutes over a 7-day period)
- 99423 (21 minutes or more over a 7-day period)
- Virtual check-ins (HCPCS code G2012) and remote evaluation of recorded videos or images (HCPCS G2010) are also reimbursable using the new G0071 code.
More information about safety-net provider billing
For more details about billing as an RHC or FQHC during the COVID-19 public health emergency, see:
- New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PDF) — from the Centers for Medicare & Medicaid Services
- Federally Qualified Health Centers & Rural Health Clinics Acting as Distant Site Providers in Medicare (PDF) — from the National Telehealth Policy Resource Center