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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 7 Rural Health Clinic : 7.2 Services, Benefits, Limitations, and Prior Authorization : 7.2.3 Hospital-Based Rural Health Clinic Services

Hospital-based RHCs must use the encounter code T1015. A hospital-based RHC is paid based on an all-inclusive encounter rate. One of the following modifiers must be submitted for general medical services: AH, AJ, AM, SA, TD, TE, or U7.
The services listed below must be submitted using the physician’s Texas Provider Identifier (TPI) and the appropriate benefit code:
These services must be submitted with an AM, SA, or U7 modifier if performed in an RHC setting. Claims are paid under the PPS reimbursement methodology. When submitting a claim on the CMS‑1450 paper claim form, providers must use the appropriate national POS (72) for an RHC setting.
Outpatient hospital services (including emergency room services) and inpatient hospital services provided outside the RHC setting are to be submitted using the individual or group physician provider identifier. Hospital-based RHCs must submit claims for pneumococcal and influenza vaccines as non-RHC services, under their hospital provider identifier.

Texas Medicaid & Healthcare Partnership
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