US · guidance
CMS Pub. 100-02, ch. 13, § 90
RHC and FQHC Charges, Coinsurance, Deductible, and Waivers
Except for certain preventive services for which the coinsurance is statutorily waived, the
beneficiary in an RHC must pay the deductible and coinsurance amount, and the
beneficiary in an FQHC must pay the coinsurance amount (there is no Part B deductible
in FQHCs for FQHC-covered services). For RHCs, the coinsurance is 20 percent of the
total charges. For FQHCs, the coinsurance is 20 percent of the lesser of the FQHC’s
charge for the specific payment code or the PPS rate. For claims with a mix of waived
and non-waived services, applicable coinsurance and deductibles are assessed only on the
non-waived services. For both RHCs and FQHCs, coinsurance for care management and
virtual communication services is 20 percent of the lesser of submitted charges or the
payment rate.
History
(Rev. 252, Issued: 12-07-18, Effective: 01-01-19, Implementation: 01- 02-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8320e2e2537776c1fa68eb111ce4bce530d1defc21a6a2b2309d9eb2df1dd4db
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