Billing for Nursing Visits in Home Health Shortage Areas by an RHC or FQHC

Section 1861(aa)(1)(C) of the Social Security Act authorizes Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) located in areas with a shortage of home health agencies to furnish part-time or intermittent nursing care and related medical supplies (other than drugs and biologicals) by a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) to a homebound individual under a written plan of treatment. The current evaluation and management codes for home health visits are not billable by RNs or LPNs furnishing RHC or FQHC home health visits. Beginning with dates of service on or after October 1, 2016, RHCs and FQHCs should bill Healthcare Common Procedure Coding System (HCPCS) code G0490 for these visits. HCPCS code G0490 will be paid as a visit:

  • Under the RHC all-inclusive rate payment system when reported on a RHC claim with revenue code 052X and modifier ‘CG,’ or
  • Under the FQHC Prospective Payment System when reported on a FQHC claim with revenue code 052X and HCPCS code G0466 or G0467