How are Rural Health Centers (RHCs) reimbursed under the Medicaid Women’s Health Program?
RHCs are reimbursed for services under the prospective payment system as they are for family planning services under Medicaid. Procedure codes 99204, 99214, J7300, and J7302 are the only allowable codes for RHCs. Family planning services provided by an RHC will not be paid if billed using the RHC’s provider identifier, but may be billed using a physician’s or NP’s provider identifier. An RHC can also apply for enrollment as a family planning agency and bill using the family planning agency’s provider identifier. These services provided to an RHC client must be billed using modifiers AJ, AM, SA, or U7. These services must be billed using the appropriate national place of service (72) for an RHC setting.
