Modifier CG

Effective October 1, 2016.

Noridian accepts modifier CG on Rural Health Clinics (RHC) claims and claim adjustments.

Correct Use

  • RHCs must report modifier CG on one revenue code 052x and/or 0900 service line per day, which includes all charges subject to coinsurance and deductible for the visit. RHCs should report all services furnished during visit on one claim

For RHCs, the coinsurance is 20 percent of the charges. Therefore, coinsurance and deductible will be based on the charges reported on the revenue code 052x and/or 0900 service line with modifier CG. RHCs will continue to be paid an all-inclusive rate (AIR) per visit.

Charges for the additional service lines are packaged/bundled in the qualifying visit service line and displayed on the line for the specific service. Medicare does not pay or adjudicate the total line (0001 revenue code). Payment is based on the qualifying visit line.

RHC Services Revenue Code Modifier Reimbursement
Initial Visit 52X and or 900 CG AIR
subject to coinsurance and deductible
Subsequent Visit 52X 25 or 59 AIR
subject to coinsurance and deductible
Additional Services All valid revenue codes are accepted except 002x-024x, 029x, 045x, 054x, 056x, 060x, 065x, 067x-072x, 080x-088x, 093x, and 096x-310x Valid modifiers, if applicable Informational only; packaged/bundled
Qualified Preventive Service (Refer to Qualifying Visit List) 52X CG AIR
subject to coinsurance and deductible
Home Health Visits (HCPCS G0490) 52X CG AIR
subject to coinsurance and deductible

 

Finally, the HCPCS reporting requirements have no impact in the way that telehealth or chronic care management (CCM) services are reimbursed.

Resources

 

Last Updated Fri, 28 Feb 2020 14:05:01 +0000