NARHC Elevates CPT Category II Code Issue with Advocacy to the CMS Administrator


For several months, NARHC has been engaging with various CMS staff in an attempt to resolve the CPT Category II code issue for RHCs.

For context, RHCs are currently unable to report CPT Cat II codes on claims without most Medicare Administrative Contractors (MACs) rejecting the entire claim. However, CPT Cat II codes would allow RHCs to easily report and have certain quality measures appropriately tracked.

This is a significant barrier to RHC participation in a variety of value-based care models and we believe that if CMS instructed the MACs to process claims with CPT Category II codes instead of rejecting those claims, the issue would be resolved.

Despite their best efforts to understand and address our concerns, to date, CMS staff have been unable to commit to fixing this issue. Therefore, NARHC recently sent a letter to the CMS Administrator and various other CMS officials regarding this significant barrier.

NARHC will continue to advocate for a solution to this issue and keep the RHC community informed of all updates.

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National Association of Rural Health Clinics