Rural Health Clinics (RHC) Billing Venipuncture with Incorrect Revenue Codes

Published 03/25/2020

Venipuncture (CPT code 36415) is considered as a professional service versus laboratory service in the Rural Health Clinic (RHC) setting. If the venipuncture is ordered and performed during a medically necessary face-to-face encounter with a physician or nonphysician practitioner, the CPT code and charge are listed separately on the RHC UB-04 claim and the charge rolled into the total charges. Venipuncture is included in the All Inclusive Rate (AIR) and the Perspective Payment System (PPS) per diem payment and is not separately billable. RHCs should report CPT code 36415 with revenue code 030X and 031X to avoid receiving reason code 32402.

Please refer to in MM9269 (PDF, 139 KB) — Required Billing Updates for Rural Health Clinics, CMS IOM 100-2, Chapter 13 (PDF, 282 KB) and IOM 100-4, Chapter 9 (PDF, 241 KB).