CMS will transition from requiring RHCs and FQHCs to report the single HCPCS code G0511 for general care management to utilizing individual CPT and HCPCS codes that more accurately reflect the services provided. This change will allow the billing of add-on codes related to care management and will introduce Advanced Primary Care Management (APCM) services, enabling RHCs and FQHCs to receive payments based on the national non-facility Medicare Physician Fee Schedule (MPFS). Payments will be issued in addition to the All-Inclusive Rate (AIR) for RHCs and the Prospective Payment System (PPS) for FQHCs.
CMS is finalizing the allowance for direct supervision through interactive audio and video telecommunications, with the definition of “immediate availability” expanded to include real-time communication through December 31, 2025. Additionally, RHCs and FQHCs can temporarily report services delivered via telecommunication technology, including audio-only methods, using HCPCS code G2025 through the end of 2025. The in-person visit requirement for mental health services provided through communication technology will remain suspended throughout 2025.
A new payment rate will be established for RHCs and FQHCs providing four or more services per day, expanding the current rate that applies only when three services are provided. This adjustment aims to align payments more closely with those in hospital outpatient departments.
Effective July 1, 2025, RHCs and FQHCs will be able to bill for Part B preventive vaccines and their administration fees at the time of service rather than through the annual cost report. This change enhances the timeliness of payments, reflecting rates from other healthcare settings.
Dental services that are inextricably linked to covered medical services will now be recognized as RHC and FQHC services, eligible for payment under the AIR and PPS. Additionally, dental services can be billed separately when they are inextricably linked to a medical visit on the same day. New operational requirements for claims to allow submitting the KX modifier will be effective July 1, 2025.
The outdated RHC productivity standards, last updated in 1982 and impacting AIR, will be removed for cost reporting periods starting on or after January 1, 2025.
The final update for the FQHC market basket in CY 2025 is set at 3.4%, reflecting a 4.0% increase from the 2022-based market basket, adjusted by 0.6 percentage points for productivity.
Changes to RHC Conditions for Certification will clarify the requirement for primary care services rather than focus on being “primarily engaged” in such services. Additionally, the list of mandatory lab services will be updated to remove outdated tests and reflect modern lab techniques.
Published: 12/17/2024
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