CMS Pub. 100-02, ch. 13, § 240

Virtual communication services are RHC and FQHC services and include

communications-based technology and remote evaluation services. The RHC and

FQHC face-to-face requirements are waived when these services are furnished to an

RHC or FQHC patient.

Effective January 1, 2019, RHCs and FQHCs receive an additional payment for the

costs of communication technology-based services or remote evaluation services that

are not already captured in the RHC AIR or the FQHC PPS payment when the

requirements for these services are met. Coinsurance and deductibles apply to RHC

claims, and coinsurance applies to FQHC claims for these services.

Requirements

The following requirements must be met for RHCs and FQHCs to bill for virtual

communication services:

• At least 5 minutes of communications-based technology or remote evaluation

services are furnished by an RHC or FQHC practitioner to a patient that has had a

billable visit in the RHC or FQHC within the previous year; and

• The medical discussion or remote evaluation is for a condition not related to an

RHC or FQHC service provided within the previous 7 days, and does not lead to an

RHC or FQHC service within the next 24 hours or at the soonest available

appointment.

If the discussion between the patient and the RHC or FQHC practitioner is related to a

billable visit furnished by the RHC or FQHC within the previous 7 days or within the

next 24 hours or at the soonest available appointment, the cost of the RHC or FQHC

practitioner’s time would be included in the RHC AIR or the FQHC PPS payment and

is not separately billable.

Beneficiary consent to receive virtual communication services may be obtained under

general supervision by auxiliary staff.

Payment for Virtual Communication Services

Virtual communication services furnished by RHCs and FQHCs on or after January 1,

2019 through December 31, 2025, are paid at the average of the national non-facility

PFS payment rate for HCPCS code G2012 (communication technology-based services),

and HCPCS code G2010 (remote evaluation services), when the virtual communication

HCPCS code, G0071, is on an RHC or FQHC claim, either alone or with other payable

services. The payment rate for HCPCS code G0071 is updated annually based on the

PFS amounts for these codes.

Effective January 1, 2026, RHCs and FQHCs must report the individual CPT/HCPCS

base codes and add-on codes for each of the virtual communication services. Billing of

the individual codes replaced the reporting of HCPCS code G0071. Virtual

communication services will be paid separately at the national non-facility PFS

payment rates. A claim should not contain both G0071 and the corresponding

CPT/HCPCS codes. Only the individual CPT/HCPCS codes will be paid.

Note: Due to the similarities between CPT code 98016 and HCPCS code G2012,

HCPCS code G2012 was replaced with CPT 98016. That is, HCPCS code G2012 was

terminated effective December 31, 2024.