Skip to Main Content

Federally Qualified Health Centers (FQHC) Center

Spotlights

  • New Virtual Communication Services

    Effective January 1, 2019, FQHCs can receive payment for Virtual Communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an FQHC practitioner to a patient who has had an FQHC billable visit within the previous year, and both of the following requirements are met:

    • The medical discussion or remote evaluation is for a condition not related to an FQHC service provided within the previous 7 days, and
    • The medical discussion or remote evaluation does not lead to an FQHC visit within the next 24 hours or at the soonest available appointment.

    To receive payment for Virtual Communication services, FQHCs must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes.

    RHC face-to-face requirements are waived when these services are furnished to an FQHC patient, and coinsurance applies.

  • 2018 Update - Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 614KB] and MM10350 [PDF, 181KB]

  • New FQHC Care Management Services

    Effective January 1, 2018, FQHCs can receive payment for Chronic Care Management (CCM) or general Behavioral Health Integration (BHI) services when 20 minutes or more of CCM or general BHI services are furnished and G0511 is billed either alone or with other payable services on an FQHC claim.

    Effective January 1, 2018, FQHCs can receive payment for psychiatric Collaborative Care Model (CoCM) services when 70 minutes or more of initial psychiatric CoCM services or 60 minutes or more of subsequent psychiatric CoCM services are furnished and G0512 is billed either alone or with other payable services on an FQHC claim.

    CCM services furnished on or before December 31, 2017 will continue to be processed and paid when CPT code 99490 is billed alone or with other payable services on an FQHC claim. Service lines reported with CPT code 99490 will be denied for dates of service on or after January 1, 2018.

    Care Management Services in RHCs and FQHCs - FAQs - (Updated on 2/27/2018) [PDF, 212KB] .

    Additional Information - MM10175 [PDF, 332KB]   and Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program.

  • 2018 FQHC Booklet
  • FQHC PPS Geographic Adjustment Factors (GAFs) for Services Furnished 1/1/18 – 12/31/18
  • FQHC PPS Specific Payment Codes [PDF, 323KB]   – (Updated on 12/7/17)
  • FQHC Preventive Services [PDF, 450KB] - (Updated on 8/10/16)
  • Effective 1/1/16, a clinic that is operated by a tribe or tribal organization under the Indian Self-Determination Education and Assistance Act, and was billing as if it were provider-based to an IHS hospital on or before 4/7/00, and is no longer operating as a provider-based department of an IHS hospital, may be certified as a grandfathered tribal FQHC. See MM9267 [PDF, 50KB]  and the Grandfathered Tribal FQHCs page.
  • Questions on the FQHC PPS?  Email FQHC-PPS@cms.hhs.gov

MLN Connects Newsletter

  • Subscribe now to receive the weekly MLN Connects® newsletter for the latest Medicare Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.

Important Links

Payment Policy/Billing

Policy/Regulations

FQHC PPS Geographic Adjustment Factors (GAFs)

FQHC PPS Training and Information

Enrollment/Certification

Legislation

CMS Manuals & Transmittals

Additional CMS Information

How to Stay Informed

.