FQHC – FEDERALLY QUALIFIED HEALTH CENTER
FQHC is a reimbursement designation from the Bureau of Primary Health Care and CMS
of US department of health and human services.
- Provider based FQHC bill under parent provider.
- Medicare Part B Deductible does not apply for FQHC services.
- Billed encounter rate.
Major CPT:
CPT | Description |
| G0466 | New patient one on one visit with FQHC practitioner |
| G0467 | Established patient one on one visit with FQHC practitioner |
| G0468 | IPPE or AWV : Initial Preventive Physical Examination / Annual Well Visit |
| G0469 | Mental health new patient |
| G0470 | Mental health established patient |
In FQHC billing, the appropriate Medicare G code for E & M services and the Medicaid’s T1015 usage is critical for obtaining revenue from these payers.
G codes are never billed to the secondary.
Medicare is never a secondary payer for patients who receive care from FQHC.
FQHC practitioners are
- Physician
- NP (Nurse Practitioners)
- PA (Physician Assistant)
- CNM (Certified Nurse Midwife)
- CP (Clinical Psychologist)
- CSW (Clinical Social Worker)
FQHC Services include:
- Face to face medical or mental health services
- Advance care planning
- Chronic care management
- Principal care management
- Transitional care management
- Hepatitis C screenings
- IPPE and AWV
- Screening mammography
- Screening pap smear and pelvic exam
- Prostrate & Colorectal cancer screening
- Diabetes screening
- Bone mass management
- Cardiovascular screening blood tests
- Venipuncture when rendered at FQHC
- Ultrasound screening for abdominal aortic aneurysm
- Prenatal and Perinatal services
ACP – Advance Care Planning is considered a face to face service between a practitioner and a patient on advance directives and it is a stand-alone billable FQHC visit.
If an ACP is rendered on the same day as the AWV it is considered a preventive service and must be reported with Modifier 33.
From January 1, 2022 through December 31, 2022, the FQHC PPS base payment rate is $180.16. The 2022 base payment rate reflects a 2.1 percent increase above the 2021 base payment rate of $176.45.
Comment
Ahmed Ali
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusm tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim Magna, sed diam nonumy eirmod tempor.