Infusion Services

In A Rural Health Clinic

Quest ion:

If we perform infusion/hydration services at our rural health clinic (RHC), are tehse billable and paid under AIR, or do we need to bill under the hospital umbrella?Also, is there other information regarding billing Medi-Cal that you can provide?

Answ er:

Yes, the RHCshould report hydration or infusions performed at the RHCon claims submitted to Medicare, although the addition of the IVtherapy codes to the RHCvisit code will not increase Medicare reimbursement.

Medicare has required RHCs to provide detailed CPT®/HCPCSreporting for most services performed at the clinic, just as the clinic would report for any other payer, since April of 2016 For Medicare, the RHCis reimbursed on a cost-reimbursement basis through an ?All Inclusive Rate?, which is payable on one of the RHCQualifying Visit codes ? no additional payment will be made for the hydration or infusion code

Typically, one of the qualifying visit codes would be billed together with the infusion or hydration code Only ancillary diagnostic services, such as labs and imaging procedures, are billed to Medicare by the ?host? provider, the hospital. IV therapy is not an ancillary service ? when performed in the clinic setting, infusion services are therapeutic RHC provider services.

Infusion Servicesin Rural Health Clinic

Similar to Medicare, Medi-Cal reimburses RHCs on a cost basis, which boils down to a single payment on each RHCvisit which, in aggregate, will cover the cost of operating the RHC

It does not appear that Medi-Cal will provide separate or additional reimbursement for IV therapy performed in the RHC The Medi-Cal provider manual for RHCs at https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-MTP/Part2/rural.pdf does not offer guidance on HCPCS/CPT® reporting, and consequently I found no online instruction on the requirement to fully report all services rendered during a visit.

To obtain greater clarity on Medi-Cal?s coding requirements, we recommend that you reach out to your Medi-Cal provider relations rep.

We found the following contact information on the Medi-Cal provider publications website: