CMS Releases Updates FQHC/RHC Guidance, Including Telehealth

In mid-March, the Centers for Medicare and Medicaid Services (CMS) announced that they had updated their Medicare Learning Network (MLN) booklets for federally qualified health centers (FQHCs), rural health clinics (RHCs) and mental health services. The Medicare MLN booklets explain national Medicare policies on coverage, billing and payment rules for specific provider types. The telehealth related changes incorporate the extensions to pandemic telehealth flexibilities made by the Consolidated Appropriations Act (CAA), 2023, as well as changes to policy that were made in the 2024 Final Physician Fee Schedule. The major telehealth changes for the FQHC/RHC booklets include:

• An allowance for FQHCs and RHCs, starting Jan. 1, 2024, to bill remote physiologic monitoring (RPM), remote therapeutic monitoring (RTC), community health integration (CHI), principal illness navigation (PIN), and PIN-Peer Support (PIN-PS) by billing the general care management code, 0511. Previously, remote monitoring was considered bundled under the FQHC/RHC’s all-inclusive rate and not reimbursed separately at all.
• The booklet now specifies that FQHCs/RHCs can provide mental health visits using interactive, real-time telecommunication technology. However, the in-person visit mandated by the CAA, while currently waived, will go into effect Jan. 1, 2025.

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