When one or more preventive service that meets the specified criteria is provided as part of an RHC visit, charges for these services must be deducted from the total charge for purposes of calculating beneficiary coinsurance and deductible. For example, if the total charge for the visit is $150, and $50 of that is for a qualified preventive service, the beneficiary coinsurance and deductible is based on $100 of the total charge.
To ensure coinsurance and deductible are waived for qualified preventive services, RHCs must report an additional revenue line with the appropriate site of service revenue code in the 052X series with the approved preventive service HCPCS code and the associated cha
The services reported without the HCPCS code will receive an encounter/visit payment. Payment will be based on the all-inclusive rate, coinsurance and deductible will be applied. The qualified preventive service will not receive payment, as payment is made under the all-inclusive rate for the services reported on the first revenue line. Coinsurance and deductible are not applicable to the service line with the preventive service.
If the only service provided is a preventive service, e.g., a screening pelvic exam, report only one line with the appropriate site of service revenue code (052X) and the preventive service HCPCS code. The services will be paid based on the all inclusive rate. Coinsurance and deductible are not applicable.