Rural Health Clinics and CMS Prepare for October 1st Use of CG Modifier

Rural Health Clinic (RHC) claims with CPT codes outside of the “Qualifying Visit List” (QVL) performed since April 1, 2016 are on hold for reimbursement. The Centers for Medicare and Medicaid (CMS) failed to recognize the minor office procedural services commonly performed in RHCs, leaving many off the Qualifying Visit List.  While these claims accumulate in clinic billing systems, CMS is preparing for their October 1st release for proper adjudication.  RHCs were advised to use a CG modifier on the 521 or 900 revenue code that represents the total charges subject to patient coinsurance and deductible.  The CG modifier will point the MACs to the correct service line for processing and eliminate the need for CMS to continually review and update the Qualifying Visit List for the variety of minor office procedural services performed in RHCs.  MLN Matters number SE1611 and MM9269 has background details. Bye bye QVL, and hello CG modifier.

If you have any questions about how the CMS changes affect your Rural Health Clinic, contact the Anders Health Care Group.