32291

FISS Narrative:

  • For dates of service on or after August 1, 2000: hospital-based RHCs (3975-3999, 3400-3499, 8500-8899) cannot bill revenue codes other than 52x and 91x on 71x type of bill
  • Resubmit these services (revenue codes not equal to 52x or 91x) on a hospital bill type 13x or 14x using the hospital provider number

Explanation and suggestion:

  • This reason code is directly related to the limitation of services that may be billed on a 71x type of bill (TOB) by a rural health clinic (RHC) provider
  • The basic services that are expected on this TOB are the clinic visit (revenue code 52x) and any outpatient psychiatric services (revenue code 91x)
  • For a hospital-based RHC, most other services that are not included in the clinic visit would be billed under the main hospital provider number
  • The exceptions, which are stated in this reason code narrative, are mammography services (revenue codes 401 and 403), glaucoma screening (revenue code 770 with HCPCS code G0117 or G0118), and the treatment of diabetic patients with diabetic sensory neuropathy and/or LOPS (loss of protective sensation) (revenue code 940 with HCPCS code G0245, G0246 or G0247)
  • Any services other than those indicated here being billed on a 71x TOB will be returned to provider (RTP) with this reason code

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