November 16, 2021: High Cost Clinic Excluded Codes

November 16, 2021: Attention Rural Health, Tribal Health, and Federally Qualified Clinic Providers: As a reminder, when billing for high-cost clinic excluded procedure code(s), the code must be reported at the specific claim service line. High-cost clinic excluded procedure codes cannot be combined into the claim service line reporting the payment code for proper claim reimbursement to occur. If the excluded code(s) are not priced at the fee set by the facility, and instead priced at $0.00 or $0.01, the CHAMPS system will adjudicate the claim using the "lesser of" logic and reimburse accordingly.