American Association of Medical Audit Specialists

CMS updated the rural health clinic (RHC) all-inclusive rate for CY 2025. The payment limit per visit for independent and provider-based RHCs in hospitals with 50 or more beds is $152.00.

The payment limit per visit for specified provider-based RHCs with an April 1, 2021, established payment limit that continue to meet the qualifications in section 1833(f)(3)(B) of the Social Security Act is the greater of these amounts:

1. Your payment limit per visit starting January 1, 2024, increased by 3.5%
2. The national statutory CY 2025 payment limit per visit of $152.00

More Information:

• Medicare Claims Processing Manual, Chapter 9 (PDF), section 20.2
• Instruction to your Medicare Administrative Contractor (PDF)