US · guidance
CMS Pub. 100-04, ch. 9, § 40.2
Part B Coinsurance
After any applicable deductibles have been satisfied, RHCs paid under the AIR system
will be paid 80 percent of their AIR. The patient is responsible for a coinsurance amount
of 20 percent of the charges after deduction of the deductible, where applicable.
Effective for dates of service on or after January 1, 2011, coinsurance is not applicable
for certain preventive services. See section 70 of this manual for information on how to
bill for preventive services on a RHC and FQHC claims.
FQHCs paid under the PPS will be paid 80 percent of the lesser of the FQHC actual
charge for the specific payment code or the adjusted PPS rate. The patient is responsible
for a coinsurance amount of 20 percent of the lesser of the FQHCs actual charge for the
specific payment code or the adjusted PPS rate. See section 60.2 for more information on
the FQHC specific payment codes.
History
(Rev. 13264, Issued:06-09-25; Effective: 06-02-25; Implementation: 06-02-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a2afe920af2ba7a90ef29bf0f48e9b99ab8a94bc4f0ab119f9c9a2485abd65e2
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