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Federally Qualified Health Centers (FQHC) Center


  • New Proposals for RHCs and FQHCs on Care Management Services and ACO Assignments - Listening Session

    Tuesday, August 1 from 2 to 3:30 pm ET

    Register for Medicare Learning Network events here:

    During this call, CMS experts review proposals for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) in the Physician Fee Schedule proposed rule on requirements and payment for Care Management Services, which includes Chronic Care Management (CCM), General Behavioral Health Integration (BHI), and Psychiatric Collaborative Care Model (CoCM) services. Learn about the CMS CCM Campaign and the proposed new process for using RHC and FQHC claims to assign beneficiaries to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program.

    A question and answer session follows the presentation. We will open the lines for feedback. Note: feedback received during the listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by the close of the comment period on September 11, 2017.

    Proposed New Care Coordination Services and Payment for RHCs and FQHCs [PDF, 364KB]  

  • Chronic Care Management (CCM) Services – FQHCs can receive payment for CCM when CPT code 99490 is billed alone or with other payable services on a FQHC claim. FQHCs are not authorized to bill for any other CCM or behavioral health integration (BHI) services, and no other CCM or BHI codes should be used. For other information on CCM, please see the MLN Matters Article and FAQs.
  • 2017 Update - Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 581KB] and MM9864 [PDF, 59KB]
  • FQHC Fact Sheet – (Updated on 1/1/17)
  • FQHC PPS Geographic Adjustment Factors (GAFs) for Services Furnished 1/1/17 – 12/31/17
  • FQHC PPS Specific Payment Codes [PDF, 336KB]   – (Updated on 12/22/16)
  • 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

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