National Association of Rural Health Clinics Research and Education Foundation
NARHC REF Lookup Tool Portal
OVERVIEW
The National Association of Rural Health Clinics Research and Education Foundation (NARHC REF) lookup tool is designed to provide information on the Healthcare Common Procedure Coding System (HCPCS) codes and Current Procedural Terminology (CPT) codes used by Rural Health Clinics (RHCs) for services provided to Medicare Fee-for-Service (FFS) beneficiaries. This list of codes was developed using the health care claims data (5% sample) outpatient and carrier file claims for the years 2019-2021 and adjusted statistically to estimate overall use across all RHCs. Searches will provide the following information for each code used by RHCs during the claim year:
- HCPCS/CPT code
- Code description
- Claim year (2019, 2020, or 2021)
- The frequency of use for the code
The data are available for all RHCs, Independent/freestanding RHCs only, and Provider-Based RHCs only by selecting the desired type of analysis using the search links available by clicking on the Data tab.
- All RHCs (includes all independent/freestanding and provider-based RHCs)
- Independent/Freestanding RHCs only
- Provider-based RHCs only
The database is searchable by clinic type, code, and code description. Users can select from these search criteria and tailor searches to meet their needs.
VALUE TO USERS
The data portal allows users to monitor changes in the types of HCPCS/CPT codes that RHCs use over time to respond to changing Medicare payment policies and clinical patterns. For example, these data can be used to monitor changes in telehealth use, Medicare Annual Wellness Visits, care management, or behavioral health substance use codes over time.
LIMITATIONS
Please note that this website is intended as a helpful aid for RHC stakeholders to use as a quick lookup and reference guide on the HCPCS/CPT codes used by RHCs to describe the services provided to beneficiaries covered by the traditional Medicare program during each claim year. The fact that RHCs used these codes to describe services provided to Medicare beneficiaries does not imply that RHCs received reimbursement for each service as many were provided under the all-inclusive rate (AIR) payment methodology used by RHCs.
The estimates were made using the Medicare Limited Data Set files based on a 5% random sample of beneficiaries covered by the traditional Medicare program. Specifically, we analyzed claims from the outpatient and carrier files to identify the HCPCS/CPT codes reported by RHCs on their claims for services provided to traditional Medicare beneficiaries for the years 2019-2021. We weighted the claims to estimate HCPCS/CPT code use by the entire population of RHCs. The data in the lookup tool provides an estimate of the HCPCS/CPT codes used by all RHCs (based on the codes reported by RHCs for services provided to traditional Medicare beneficiaries represented in the 5% sample.) We cannot vouch for the accuracy of all the codes used. We recommend that RHCs conduct appropriate due diligence with Medicare, Medicaid, and commercial payers prior to using any of the codes reported in this file.
