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.