Rate and limit
Independent clinics, clinics in hospitals with 50 or more beds, and clinics enrolled on or after January 1, 2021 are capped at the national limit. Certain provider-based clinics in smaller hospitals keep a facility-specific limit.
A capped per-visit rate leaves little room for leaks
Medicare pays rural health clinics an all-inclusive rate per visit, subject to a payment limit of $165 for 2026 and $178 for 2027 for most clinics. Every missed or bundled visit matters, and the cost report settles the year.
Book a demoWhat shapes an RHC payment
CMS's January 2026 rural health clinic booklet sets out the Medicare basics.
What counts as a visit
A billable visit is a medically necessary face-to-face medical, mental health, or qualifying preventive visit with an RHC practitioner. Visits in a hospital outpatient department don't qualify, and same-day visits generally count once.
Outside the rate
Care coordination services are paid at the national non-facility rate with the deductible and 20% coinsurance. Their costs go in the non-reimbursable section of the cost report.
Separate the claim cycle from the cost report
Clinic staff, the cost report preparer, and billing each see a different piece of the year.
What the clinic keeps
Certification, staffing rules such as NP or PA coverage, the annual cost report, and clinical documentation stay with your clinic.
What Taiga takes on
If it fits, Taiga handles eligibility checks, claim scrubbing and submission, every denial and appeal, and patient statements.
Where a decision is needed
Telehealth coding after October 1, 2026, care coordination claims, and commercial plans that pay differently from Medicare need clear ownership.
Questions for an RHC fit call
Bring de-identified examples of a paid visit claim, a care coordination claim, and a denial. Patient details stay out of the booking form.
Independent or provider-based?
Tell Taiga whether the clinic is independent or part of a hospital, and the hospital's bed count.
What does your visit mix look like?
Estimate medical, mental health, preventive, and telehealth visits per month.
Who prepares the cost report?
Name the person or firm and how they get visit counts from your billing data.
For clinics where billing is one or two people
Relevant to a rural clinic whose small team can't keep up with denials, patient balances, and the coding changes CMS made in 2026.
No promise on RHC claims yet
Taiga has not published support for RHC billing. This page does not prepare cost reports, set your rate, or replace your clinic's compliance work.
Questions about RHC billing
What is the RHC payment limit for 2026?
$165 per visit for independent clinics, provider-based clinics in hospitals with 50 or more beds, and clinics enrolled on or after January 1, 2021. CMS lists $178 for 2027.
Can an RHC still bill non-mental health telehealth?
Yes, through December 31, 2027 under current law. For dates of service on or after October 1, 2026, CMS requires the individual CPT or HCPCS code with modifier 93 or 95 instead of G2025.
Does a second visit on the same day pay separately?
Usually not. It can when the patient returns with a new illness or injury, or has a medical and a mental health visit, an IPPE, IOP services, or a dental visit that day.
Do care coordination payments count against the per-visit limit?
No. CMS pays care coordination at the national non-facility rate, and those costs are kept out of the all-inclusive rate calculation.
Bring your clinic's payer and visit mix
Show Taiga your volume, payers, and where claims get stuck. You will hear honestly whether it fits.
System guides show possible billing handoffs, not proven specialty compatibility.