CMS Pub. 100-04, ch. 18, § 170.4.1

Payment for HIBC is based on the all-inclusive payment rate for rural health clinics (TOBs 71X)

and federally qualified health centers (TOB 77X). Hospital outpatient departments (TOB 13X)

are paid based on the outpatient prospective payment system and CAHs (TOB 85X) are paid

based on reasonable cost. CAHs electing the optional method of payment for outpatient services

are paid based on 115% of the lesser of the Medicare Physician Fee Schedule (MPFS) amount or

submitted charge.

Effective for dates of service on and after November 8, 2011, deductible and coinsurance do not

apply to claim lines with G0445.

HCPCS code G0445 may be paid on the same date of service as an annual wellness visit,

evaluation and management (E&M) code, or during the global billing period for obstetrical care,

but only one G0445 may be paid on any one date of service. If billed on the same date of service

with an E&M code, the E&M code should have a distinct diagnosis code other than the diagnosis

code used to indicate high/increased risk for STIs for the G0445 service. An E&M code should

not be billed when the sole reason for the visit is HIBC to prevent STIs.

For Medicare Part B physician and non-practitioner claims, payment for HIBC to prevent STIs is

based on the MPFS amount for G0445.