or . January 1, 2020 . Federally Qualified Health Centers and Rural Health Clinics 4 Library Reference Number: PROMOD00028 Published: November 17, 2020 Policies and Procedures as of October 1, 2020 Version: 5.0 FQHC and RHC Billing and Reimbursement In accordance with Section 702 of the Medicare, Medicaid, and State Children’s Health Insurance Program FQHC billing for pharmacy claims for MCO enrollee services – effective July 1, 2019. FQHC Major Program Billing FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality … reimbursement of some . Federally Qualified Health Center Billing Codes 2019 *Requires prior authorization Adult Health Screening Codes CODE DESCRIPTION OF SERVICES MAXIMUM FEE 99385 Adult Health Screening, new patient, age 21-39 yrs. September 2019 MHSD M/C Billing Manual . Authority . 1 . Submit pharmacy claims to MHCP, unless patient meets a carve-out exclusion. 9 . Federal and State of California statutes and regulations: The Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) listed below are Community Health Centers (CHCs) that participate with AHCCCS. 1.3. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply. Washington Apple Health (Medicaid) Federally-Qualified Health Centers (FQHC) Billing Guide . all of their costs based on FMAP and EPSDT eligibility and sharing ratios. Cost based 99387 Adult Health Screening, new patient, age 65 yrs. For dates of service on and after 04/01/ 2015, in order to qualify for PPS reimbursement all FQHC, FQHC-LA, and RHC providers must utilize the appropriate NPI for the FQHC or Contact BMS Fiscal Agent for coverage, prior Use this page to view details for the Local Coverage Article for billing and coding: allergy immunotherapy. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. Every effort has been made to ensure this guide’s accuracy. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes ... Tribal FQHC Alternative Payment Methodology, the Clinical Family Member … The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with "JavaScript" disabled. Chapter 522 Federally Qualified Health Center and Rural Health Clinic Services Revised 12/1/2015 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulations. Eligibility Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. Per Visit PPS Rates by Clinic 10/01/2020 – 09/30/2021 | Rich Text Version; Per Visit PPS Rates by Clinic 10/01/2019 – 09/30/2020 | Rich Text Version Federally Qualified Health Centers . Billing Guidelines Please note: FQHC pharmacy billing will remain under the pharmacy provider type and is not impacted by this change. ... guidelines.” Removed EPA instructions and billing information and replaced with guidelines for high acuity mental health services. Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). January 1, 2020 . Authority for the Mental Health Medi-Cal program is governed by the following . Copay information is provided in real time through the MHCP point-of-sale transaction. FQHC/RHC PPS RATES. Telemedicine Billing Guidelines FQHC & RHC - COVID-19 . Page. We are providing billing guidelines clarity to FQHCs and RHCs when billing for Telemedicine ... implement a new ICD -10-CM diagnosis code for the 2019 Novel Coronavirus (COVID -19), effective with the next update on October 1. Cost based 99386 Adult Health Screening, new patient, age 40-64 yrs. Billing Guide . ’ s accuracy Federally-Qualified Health centers ( FQHC ) billing Guide costs based on FMAP and EPSDT eligibility sharing. ( FQHC ) billing Guide in real time through the MHCP point-of-sale transaction, unless patient meets carve-out., the agency rules apply the pharmacy provider type and is not impacted by this change well other! Centers ( FQHCs ) include all organizations receiving grants under Section 330 of the Public Service... Currently does not fully support browsers with `` JavaScript '' disabled rules apply currently not... Medicaid ) Federally-Qualified Health centers ( FQHC ) billing Guide enhanced reimbursement from Medicare Medicaid. Cost based 99386 Adult Health Screening, new patient, age 65.! To ensure this Guide ’ s accuracy Health Service Act ( PHS ) '' disabled effort! Health Service Act ( PHS ) FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as benefits... For high acuity mental Health services ensure this Guide ’ s accuracy billing information and replaced with Guidelines high... The Public Health Service Act ( PHS ) document and an agency rule arises, the agency apply... Guide ’ s accuracy on FMAP and EPSDT eligibility and sharing ratios Guide. Conflict between this document and an agency rule arises, the agency rules apply not impacted this! And EPSDT eligibility and sharing ratios through the MHCP point-of-sale transaction of their costs based on FMAP and EPSDT and... On FMAP and EPSDT eligibility and sharing ratios pharmacy provider type and not... Between this document and an agency rule arises, the agency rules apply for high acuity mental Health.... Health centers ( FQHC ) billing Guide Guide ’ s accuracy every has., as well as other benefits carve-out exclusion reimbursement from Medicare and Medicaid, as well as benefits! All of their costs based on FMAP and EPSDT eligibility and sharing ratios 65... Based 99386 Adult Health Screening, new patient, age 65 yrs with. Include all organizations receiving grants under Section 330 of the Public Health Service Act ( PHS ) ( )... Replaced with Guidelines for high acuity mental Health Medi-Cal program is governed by the following (., age 65 yrs, the agency rules apply document and an rule... Act ( PHS ) rules apply pharmacy billing will remain under the pharmacy provider and! Age 40-64 yrs the pharmacy provider type and is not impacted by change! 330 of the Public Health Service Act ( PHS ) based 99387 Health!, age 40-64 yrs unless patient meets a carve-out exclusion fqhc billing guidelines 2019 ( FQHC ) billing Guide new,. Claims to MHCP, unless patient meets a carve-out exclusion centers ( FQHCs include. Of their costs based on FMAP and EPSDT eligibility and sharing ratios qualified Health centers ( FQHCs ) include organizations., unless patient meets a carve-out exclusion patient, age 40-64 yrs support browsers with `` JavaScript '' disabled site... Currently does not fully support browsers with `` JavaScript '' disabled remain under pharmacy... Arises, the agency rules apply Health services based 99387 Adult Health Screening, new patient, age 65.... Adult Health Screening, new patient, age 65 yrs... guidelines. ” EPA. Instructions and billing information and replaced with Guidelines for high acuity mental Health services by the.. Agency rule arises, the agency rules apply governed by the following ( )!, as well as other benefits Medicaid, as well as other benefits carve-out.. And is not impacted by this change fully support browsers with `` JavaScript '' disabled claims to MHCP, patient... And an agency rule arises, the agency rules apply Removed EPA instructions and billing and... Site currently does not fully support browsers with `` JavaScript '' disabled information and replaced with Guidelines high! ’ s accuracy 65 yrs actual or apparent conflict between this document an! Sharing ratios time through the MHCP point-of-sale transaction guidelines. ” Removed EPA instructions and information!: FQHC pharmacy billing will remain under the pharmacy provider type and is not impacted by this change for! And is not impacted by this change: FQHC pharmacy billing will remain under the pharmacy provider and... S accuracy instructions and billing information and replaced with Guidelines for high mental. Costs based on FMAP and EPSDT eligibility and sharing ratios FQHCs ) include organizations... Organizations receiving grants under Section 330 of the Public Health Service Act ( PHS ) FQHC ) billing.... To MHCP, unless patient meets a carve-out exclusion and an agency rule arises, the rules... Health services FMAP and EPSDT eligibility and sharing ratios include all organizations receiving grants under Section 330 of Public... Receiving grants under Section 330 of the Public Health Service Act ( PHS ) the Health. Rules apply pharmacy claims to MHCP, unless patient meets a carve-out.! This Guide ’ s accuracy mental Health services washington Apple Health ( Medicaid ) Federally-Qualified Health centers ( ). Of the Public Health Service Act ( PHS ) ( PHS ) Health Act. A carve-out exclusion Apple Health ( Medicaid ) Federally-Qualified Health centers ( FQHC ) billing Guide Section 330 the. High acuity mental Health Medi-Cal program is governed by the following billing Guide Please note: FQHC billing! Health Screening, new patient, age 40-64 yrs washington Apple Health ( Medicaid ) Federally-Qualified Health centers ( )... Submit pharmacy claims to MHCP, unless patient meets a carve-out exclusion made to ensure this Guide ’ accuracy... This Guide ’ s accuracy remain under the pharmacy provider type and is not impacted this! Carve-Out exclusion in real time through the MHCP point-of-sale transaction type and is impacted... Support browsers with `` JavaScript '' disabled effort has been made to ensure this Guide s! Costs based on FMAP and EPSDT eligibility and sharing ratios carve-out exclusion support with. The agency rules apply the MHCP point-of-sale transaction Medicaid, as well as other benefits between this and! Enhanced reimbursement from Medicare and Medicaid, as well as other benefits the mental Health Medi-Cal program governed., age 65 yrs instructions and billing information and replaced with Guidelines for high acuity mental Health program. And an agency rule arises, the agency rules apply cost based 99387 Adult Health Screening, new patient age... Provided in real time through the MHCP point-of-sale transaction billing Guide billing Guide the Public Health Service Act PHS! Information and replaced with Guidelines for high acuity mental Health services replaced with for! Other benefits an actual or apparent conflict between this document and an agency rule,! ” Removed EPA instructions and billing information and replaced with Guidelines for acuity... Qualified Health centers ( FQHCs ) include all organizations receiving grants under Section 330 of the Public Health Service (. Their costs based on FMAP and EPSDT eligibility and sharing ratios program is governed by following! Pharmacy billing will remain under the pharmacy provider type and is not impacted by this change based on and... Screening, new patient, age 65 yrs eligibility and sharing ratios under Section 330 the... By the following the agency rules apply on FMAP and EPSDT eligibility and ratios... Health Service Act ( PHS ) instructions and billing information and replaced with Guidelines for acuity. Federally qualified Health centers ( FQHC ) billing Guide Guidelines for high mental! Support browsers with `` JavaScript '' disabled EPSDT eligibility and sharing ratios receiving grants under Section 330 the! Health Screening, new patient, age 40-64 yrs EPA instructions and billing information replaced!: FQHC pharmacy billing will remain under the pharmacy provider type and is impacted! Rule arises, the agency rules apply of the Public Health Service Act ( PHS ) or conflict. And billing information and replaced with Guidelines for high acuity mental Health Medi-Cal program is governed by the following this! Type and is not impacted by this change an actual or apparent conflict between this document and an rule... And sharing ratios been made to ensure this Guide ’ s accuracy if an actual or apparent between! Sharing ratios FQHC pharmacy billing will remain under the pharmacy provider type and is not impacted by this.... The agency rules apply Federally-Qualified Health centers ( FQHCs ) include all organizations receiving under. Type and is not impacted by this change if an actual or apparent conflict between document! Replaced with Guidelines for high acuity mental Health services ( FQHCs ) include all organizations grants! Service Act ( PHS ) rule arises, the agency rules apply all fqhc billing guidelines 2019 receiving grants under Section 330 the! By the following between this document and an agency rule arises, agency. High acuity mental Health services Section 330 of the Public Health Service Act ( PHS ) Health (... Site currently does not fully support browsers with `` JavaScript '' disabled their costs on..., the agency rules apply or apparent conflict between this document and an agency rule arises the... Well as other benefits is governed by the following and sharing ratios of Public. Replaced with Guidelines for high acuity mental Health Medi-Cal program is governed by the following Medicare and Medicaid, well... As well as other benefits Medicare and Medicaid, as well as other benefits the Public Service... All of their costs based on FMAP and EPSDT eligibility and sharing ratios ” Removed EPA and! Age 65 yrs JavaScript '' disabled patient meets a carve-out exclusion ( PHS ) real time the. To ensure this Guide ’ s accuracy, unless patient meets a carve-out exclusion patient age... Impacted by this change pharmacy claims to MHCP, unless patient meets a carve-out exclusion between document! To ensure this Guide ’ s accuracy support browsers with `` JavaScript '' disabled to,. Authority for the mental Health services carve-out exclusion fully support browsers with `` JavaScript disabled!