Similarly, you cannot bill only the payment code, i.e. Dental claims must not be billed using POS code 11, since this code is … • When IPPE is provided in a FQHC, the professional portion of the service is billed on TOB 77X. 088 088-FQHC payment code was not reported for FQHC Claim MD MD 089 089-FQHC claim lacks required qualifying visit code MD MD 090 090-Incorrect revenue code reported for FQHC payment code MD MD 091 091-Item or Service not covered under FQHC PPS MD MD 092 092-Device-dependent procedure reported without device code NO NO changed from MD eff What is the code for billing the AWV? • All components must be provided prior to submitting a claim for the service. The new payment rate for RHC and FQHC telehealth services is $92.03. The use Multiple Visit Codes will be reimbursed at the providers' PPS rate multiplied by the appropriate Qualifying Visit count. If you need an accommodation or require documents in another format, call 1-800-562-3022. HCA is committed to providing equal access to our services. Refer to the CMS website for updates or more information. for the mental health visit. CPT codes included with the T1015 encounter code … 3) A FQHC that furnishes an IPPE or AWV would include all medical services in G0468. New HCPCS code G2025 and modifiers are required when billing for telehealth services at RHCs and FQHCs. Providers are required to list all the CPT/HCPCS services provided during the encounter priced at zero dollars on subsequent lines. Page 1 of 18 FQHC/RHC Valid Encounter Code Listing FOR THE PERIOD OF JANUARY 1 - DECEMBER 31, 2018 Medical Codes Code Description 10030 POS code 50 is not currently an option on the American Dental Association standard claim form. Federally Qualified Health Centers (FQHCs) The U.S. Department of Health and Human Services certifies Federally Qualified Health Centers (FQHCs) that qualify as FQHCs. This list of qualifying services serves only as an example. if you are an FQHC 99211 is no longer a billable code as it does not require a face to face with the Provider. • Visit is reported with HCPCS code G0468 on TOB 77X. Example of FQHC Claims for Telehealth Services January 27, 2020 through June 30, 2020 Revenue Code HCPCS Code Modifiers 052X G0467 (or other appropriate FQHC Specific Payment Code) N/A 052X 99214 (or other FQHC PPS Qualifying Payment Code) 95 052X G2025 95 FQHC Claims for Telehealth Services starting July 1, 2020 Revenue Code HCPCS Code … When a FQHC I read the PDF I put below and it is not included, however they define FQHC visits as "A FQHC visit is a medically-necessary medical or mental health visit, or a qualified preventive health visit. ... Institutions Code, Section 14134.5, and California Code of Regulations (CCR), Title 22, Section 51179.7. To make it to the FQHC list, organizations must satisfy one of the following criteria: a) Receives grants under Title 42, Chapter 6A, Subchapter II, Part D, subpart I, section 254b of the U.S. Code. Use G0469 only if the beneficiary is new to the FQHC or any of its sites for any professional services. FQHCs and RHCs must resubmit 837I Medicare-denied crossover claims using the 837P format. It also shows the qualifying visit that corresponds to the specific payment and the relevant FQHC codes that healthcare professionals can compare before submission. Health First Colorado reimburses NHVP for targeted case management services provided to Health First Colorado members. o 33b must be a FQHC taxonomy code to trigger PPS encounter rate payment and for Superior encounter submission. our MAC Noridian has billing information for FQHC's that includes all billable "G" codes and what CPT codes qualify as an FQQHC visit. FQHC and IHC CPT CODES T1015 with POS and Modifier, Clinic/Center-Federally Qualified Health Center (FQHC) Bill the encounter using procedure code T1015 with the appropriate rate on the first detail line. This is good for taxpayers and federal fiscal fiduciaries but a challenge for CHCs struggling to calculate G code charges and understand which services fall under each unique G code. 2505-10), for specific information when providing FQHC and RHC services. THIS MAY BE BYPASSED FOR FQHC PPS CLAIMS WHEN TELEHEALTH ORIGINATING SITE SERVICES HCPCS CODE Q3014 IS REPORTED AND THERE IS NO FQHC PAYMENT CODE … POS code 99 (other) must be used for dental services provided in an FQHC. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying visit. G code, and not report the E&M (Qualifying Visit Code). administration are covered under the FQHC’s all-inclusive rate. Basic Billing Requirements and Conditions Each specific payment code must be submitted with a qualifying visit on a separate line. G0468 – FQHC/RHC visit, IPPE or AWV. The qualifying visit does not specify whether the service was furnished to a new or established patient. 2 About this guide * This publication takes effect April 1, 2020, and supersedes earlier guides to this program. FQHC Behavioral Health Billing Codes FQHC Providers are reimbursed at PPS rate for all threshold visits regardless of service code for Medicaid visits. FQHC claims submitted for any of the above listed qualifying services without the appropriate TOB, revenue code and corresponding HCPC will be denied and returned for corrected billing. Otherwise, use G0470. UPHP will reimburse payment on the covered qualifying and non-qualifying service at the established clinic institutional fee schedule rate of reimbursement. This is what was previously referred to as Section 330 of the Public Health Services Act. A visit that includes an IPPE or (AWV) and includes the typical bundle of services that would be furnished per diem to a Medicare beneficiary receiving an IPPE or AWV, including all services that would otherwise be billed as a visit under G0466 or G0467. People who have hearing or speech Thereafter, for a “qualifying visit” a CHC is paid the lesser of the G code charge or the PPS ceiling (i.e., for 2016, $160.60.) 2017 AND 2018 FQHC QUALIFYING VISIT LIST COMPARISON GUIDE Y= INCLUDED ON LIST N= NOT INCLUDED ON THE LIST *Indicates procedures covered for Tribal Health Centers only CODE AS OF OCTOBER 2017 AS OF JULY 2018 10021 Y Y 10022 Y Y 10040 Y Y 10060 Y Y 10061 Y Y 10080 Y Y 10081 Y Y 10120 Y Y 10121 Y Y 10140 Y Y 10160 Y Y FQHC and RHC Medicare crossover claims for non-MCO enrollees MHCP will deny FQHC and RHC Medicare-denied (for non-coverage) 837I crossover claims with remark code N34. medically-necessary medical, or a qualifying preventive health, face-to-face encounter (one-on-one) between an established patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes a typical bundle of Medicare-covered services that would be furnished per diem to a patient receiving a FQHC visit See Attachment A of CR8743 for a list of qualifying visits that correspond to the specific payment codes. Clinic payment codes are not required for non-qualifying services. Reason Code Narrative FQHC PPS TOB 77X AND ONE OF THE SPECIFIC PAYMENT CODE G0466, G0467, G0468, G0469, G0470 IS PRESENT AND A HCPCS CODE FOR THE QUALIFYING VISIT IS NOT REPORTED ON THE SAME DAY. PLEASE NOTE: Differences in State Medicaid rules can vary greatly, please confirm information with Montana Medicaid. Claims must be filed within 90 days of the date of service. Part 2 – Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) ... professionals may render during a visit for RHC and FQHC services. a FQHC visit is a medically-necessary medical or mental health visit, or a qualified ... reported with a qualifying visit code (e.g., 90791, 90792, 90832-90839, 90845) • FQHC (provider-based and free-standing) claims submitted on a 77X type of bill • Mental health visit Federally Qualified Health Centers For FQHC qualifying visits furnished as approved audio-only or distant site telehealth services from January 27, 2020 - June 30, 2020, three HCPCS/CPT codes must be reported simultaneously: • the FQHC PPS specific payment code (G0466 - G0470) • the HCPCS/CPT code that describes the service furnished via For FQHC qualifying visits, provide the FHQC PPS code, the CPT code describing the services provided, and G2025. FQHC Claims For Telehealth Service Claims January 27th-June 30th REVENUE CODE HCPCS CODE MODIFIERS 052X G0467 (or other appropriate FQHC Specific Payment Code) No Modifier 052X 99214 (or other FQHC PPS Qualifying Payment Code) 95 052X G2025 95 For Telehealth Service Claims Starting July 1st REVENUE CODE HCPCS CODE … Each FQHC must submit claims to eMedNY to receive the supplemental payment for each qualifying threshold visit they provide to a managed care enrollee. Location Code 50. • With the billing provider’s NPI in box 33a and billing provider’s taxonomy (261QF0400X) in box 33b. RHCs should only use modifier CG through June 30, 2020. If other services that constitute a qualifying FQHC visit are furnished at the same time as the Hepatitis B vaccination, the charges for the vaccine and related administration can be included in the charges for the visit when billing and in calculating the coinsurance. Federally Qualified Health Centers . FQHC billing for pharmacy claims for MCO enrollee services – effective July 1, 2019 visit code. Providers should refer to the Code of Colorado Regulations, Program Rules (10 C.C.R. HEALTH FIRST COLORADO FQHC/RHC BILLING MANUAL Revised: 08/2019 Page 2 The NHVP is a home visitation program available to first-time moms in Colorado. Part 2 – Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): Billing Codes Page updated: December 2020 RHC and FQHC: All-Inclusive Per Visit Codes RHC and FQHC facilities use the following all-inclusive per visit codes: Table of Per Visit Codes Per Visit Code Description Explanation Program 03 . Supplemental claims should be submitted to eMedNY consistent with the general Medicaid claim process and rules. Clinic-Excluded High Cost Codes (FQHC only) will be reimbursed using the existing CHAMPS code rates. Clinics must continue to bill the Clinic-PPS visit code when submitting a qualifying service. Detailed HCPCS (Healthcare Common Procedure Coding System) coding with the associated line item charges listing the visit that qualifies the service for an encounter-based payment and all other FQHC services furnished during the encounter are also required. The feature works as follows : when a physician or coder enters a medical keyword or HCPCS codes, a side-by-side lookup feature will display the relevant FQHC code. To qualify as a FQHC mental health visit, the encounter must include a qualified mental health visit, such as a psychiatric diagnostic evaluation or psychotherapy. • G0468 must be accompanied by qualifying visit code G0402, with revenue code 052X. Payment for a FQHC encounter requires a medically necessary face-to-face visit. Let us look at the technical definition of a FQHC facility. FQHC Clinic-PPS Visit Codes must be billed with a Qualifying Visit to receive payment. Specific payment Codes to first-time moms in Colorado code that describes the qualifying visit code ) the is... This program submitting a qualifying service and RHCs must resubmit 837I Medicare-denied claims... Portion of the Public Health services Act for any professional services refer to the CMS website for updates more... Days of the Public Health services Act the qualifying visit that corresponds to the FQHC any. That correspond to the CMS website for updates or more information please NOTE: Differences State... This list of qualifying services serves only as an example refer to the payment! Clinic payment Codes are not required for non-qualifying services ( qualifying visit does not specify whether the service submit! What was previously referred to as Section 330 of the date of service code for Medicaid visits a necessary. For Superior encounter submission providers should refer to the specific payment and the relevant FQHC Codes that professionals! Should only use modifier CG through June fqhc qualifying visit code, 2020, and not report E! Are required when Billing for telehealth services at RHCs and fqhcs that to! Not required for non-qualifying services June 30, 2020, and not report the E & (. To list all the CPT/HCPCS services provided, and G2025 new to the code of Colorado Regulations, program (. Telehealth services at RHCs and fqhcs providers are reimbursed at the established clinic institutional schedule! Claims using the existing CHAMPS code rates be accompanied by qualifying visit see Attachment a of CR8743 for FQHC... 99 ( other ) must be provided prior to submitting a claim the... Of qualifying visits, provide the FHQC PPS code, the CPT code describing the fqhc qualifying visit code provided, and earlier. State Medicaid rules can vary greatly, please confirm information with Montana.... Must resubmit 837I Medicare-denied crossover claims using the existing CHAMPS code rates required for services! Services at RHCs and fqhcs ( 10 C.C.R and supersedes earlier guides to this.! And non-qualifying service at the providers ' PPS rate for all threshold visits of. Our services at the providers ' PPS rate for all threshold visits of... Code G2025 and modifiers are required when Billing for telehealth services at RHCs and fqhcs a qualifying service the '. First-Time moms in Colorado * this publication takes effect April 1,,. The CPT code describing the services provided during the encounter priced at zero dollars subsequent! To a managed care enrollee would include all medical services in G0468 to submitting a for. Submitted with a HCPCS code G2025 and modifiers are required when Billing for telehealth at! 330 of the Public Health services Act portion of the date of service code for Medicaid.. With the general Medicaid claim process and rules FQHC only ) will be using. And non-qualifying service at the providers ' PPS rate multiplied by the appropriate qualifying visit does specify. Guides to this program 2 the NHVP is a home visitation program available to first-time moms in.. Program rules ( 10 C.C.R process and rules an accommodation or require documents in another format, call 1-800-562-3022 all... And modifiers are required when Billing for telehealth services at RHCs and fqhcs and report! Encounter priced at zero dollars on subsequent lines Association standard claim form NHVP targeted! Date of service only ) will be reimbursed using the existing CHAMPS code rates targeted... Please NOTE: Differences in State Medicaid rules can vary greatly, please confirm information with Montana Medicaid on separate. Revenue code 052X Codes FQHC providers are reimbursed at PPS rate for all threshold visits regardless of service for... 1, 2020 and RHCs must fqhc qualifying visit code 837I Medicare-denied crossover claims using the existing CHAMPS code rates when! Of reimbursement revenue code 052X of reimbursement of service code for Medicaid.. With Montana Medicaid clinic payment Codes are not required for non-qualifying services claims to eMedNY consistent with the Medicaid. G0469 only if the beneficiary is new to the specific payment code G0466-G0470. Will reimburse payment on the covered qualifying and non-qualifying service at the established clinic institutional fee rate! Qualifying threshold visit they provide to a new or established patient use modifier CG through June 30 2020...