part ii policies and procedures for rural health clinic services

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902.1 ICD-9-CMCodes deleted from previous editions of the ICD-9-CM are not acceptedby the Department. The special categories of codes that begin withalphabetic characters “E” (E800-E999) and “M” (M800-M9970/1) arenot accepted by the Department. The remaining special category of codeswhich begin with “V” are acceptable only if the “V” code describes theprimary diagnosis and indicates suspected or proven conditions whichwarrant medically necessary services. In coding the diagnosis on yourclaim, the code must be placed on the claim form using the identicalformat (excluding the decimal point) as shown in the ICD-9-CM(examples: 402; 4020; 40200).Rev 1/07902.2 Revenue CodesProvider-Based (Hospital-based) rural health clinics must identifyservices provided using revenue code 521 as described in the GeorgiaUniform Billing Manual when billing for rural health clinic services.Revenue code 522 is to be used for home visit services by a practitioner.Revenue code 527 is to be used by Visiting Nurse services to a member‟shome when in a home health shortage area. Revenue code 636 forinjectable drugs. Further, the clinics must use the appropriate revenuecode to specify and identify any other services provided such as:pharmacy services, medical equipment. Billing instructions for Provider-Based rural clinics are presented in Appendix E of this manual.902.3 CPTThe RHC must select the procedure code(s) that best describes theprocedure(s) performed. The following instructions apply to all clinicclaims:1. Codes deleted from previous editions of the CPT are notreimbursable and should not be submitted.2. Codes for “Unlisted Procedures” which end in “99” are not acceptedby the Department and should not be submitted.Rev 01/093. CPT modifiers for clarifying circumstances are not accepted by theDepartment for services rendered in an RHC. The appropriate “Placeof Service” codes are located on the back of the CMS-1500 claimJanuary 2012 Rural Health Clinic Services IX-4
form and must be used in lieu of the modifiers. The place of servicecode for services provided at the Clinic is “72”.4. Annual updates to the CPT are effective as soon as possible after themonth of publication. This applies to deletions, additions, and/orrevisions. Clinics will be notified on their Remittance Advices as tothe effective date of these changes. It is the clinic‟s responsibility tomaintain an up-to-date CPT publication.Rev 01/095. When billing CPT or HCPC codes the RHC should bill the appropriatePlace of Service Code on the billing Form.903. Special InstructionsRev 01/09All ““core”” services described in Section 901 which rendered by a ruralhealth clinic under this program must be performed in conjunction with avisit as described in Appendix C. Several services require special codingor other instructions described below903.1 Family Planning ServicesThe CPT procedure codes for family planning visits fall within the rangeof 99201-99215. Clinics, that provide family planning services, mustenter “FP” in item 24H on the CMS-1500 claim form. Hospital BasedRural Health clinics must enter A4 in the condition code field on the UB-92. Examples of outpatient family planning procedures are examination,IUD insertion and removal, diaphragm fitting tubal ligation, birth controlpills, artificial insemination, and other contraceptive aides.Rev 1/07 903.2 Injectable Drugs and ImmunizationsProcedure codes and descriptions for injectable drugs (other than allergyinjections and immunizations) are listed in the Department‟s Physician‟sInjectable Drug List that may be obtained from the Department‟s fiscalagent. The codes for injectable drugs are identified with a “J”, or “X”prefix and must be used in lieu of CPT codes. Allergy injections andimmunizations must be coded from the CPT. Beginning January 1, 2007the National Drug Code (NDC) number is required along with theinjectable drug code on the claim.Rev 01/09Please refer to the Health Check Manual for billing instructions related tohealth check codes and modifiers.January 2012 Rural Health Clinic Services IX-5
Page 2 and 3: PART II - POLICIES AND PROCEDURESFO
Page 4 and 5: Rev. 01/09APPENDIX AAPPENDIX BAPPEN
Page 6: . 01/09Rev. 01/09Rev. 01/09Rev. 07/
Page 10 and 11: PART II - CHAPTER 800PRIOR APPROVAL
Page 12 and 13: Rev 01/09Payments specified as the
Page 16 and 17: 903.3 Laboratory ServicesRev 01/09R
Page 18 and 19: COS 600 ID. The procedure codes for
Page 20 and 21: 904 Other Ambulatory Clinics Servic
Page 22 and 23: 4. ResidentialRev 01/09Clinics may
Page 24 and 25: 1001. Reimbursement MethodologyPART
Page 26 and 27: health clinics, and the UB-04 claim
Page 28 and 29: APPENDIX BSTATEMENT OF PARTICIPATIO
Page 30 and 31: Rev 01/09Rev 01/09Rev 01/09Example
Page 32 and 33: APPENDIX EBILLING INSTRUCTIONS AND
Page 34 and 35: PLACE OF SERVICE CODES11 - Office12
Page 36 and 37: Completion of the Health Insurance
Page 38 and 39: OrEnter the Prior Authorization Num
Page 40 and 41: enter the date.Unsigned invoice for
Page 42 and 43: Completion of the National Uniform
Page 44 and 45: FL 42FL 43FL 44FL 46FL 47Revenue Co
Page 46 and 47: FL 68thru 75Codes prefixed in „E
Page 48 and 49: Established Patient 99391 - 99395Ne
Page 50 and 51: APPENDIX HVACCINE FOR CHILDREN PROG
Page 52 and 53: (5) A request for review of a chang

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