Federally Qualified Health Centers (FQHC) Center
New Virtual Communication Services
Effective January 1, 2019, RHCs can receive payment for Virtual Communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an RHC practitioner to a patient who has had an RHC 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 RHC service provided within the previous 7 days, and
- The medical discussion or remote evaluation does not lead to an RHC 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.
Face-to-face requirements are waived when these services are furnished to an FQHC patient, and coinsurance applies. See Virtual Communication Services Frequently Asked Questions [PDF, 39KB]
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. See Care Management Services in RHCs and FQHCs - FAQs - (Updated on 01/09/2019) [PDF, 196KB] .
Grandfathered Tribal FQHCs
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
- Communication Technology Based Services and Payment for Rural Health Clinic (RHCs) and Federally Qualified Health Centers (FQHCs) [January 2019]: MM10843
- CY 2019 Payment Rate Update to the FQHC PPS. See MM10990.
- Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers [PDF, 241KB]
- Medicare Benefit Policy Internet Only Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 662KB] See MM11019 [PDF, 208KB]
- FQHC Preventive Services [PDF, 450KB] – Information on preventive services in FQHCs including HCPCS coding, same day billing, and waivers of co-insurance.
- FQHC PPS Specific Payment Codes [PDF, 323KB] (Updated 12/7/2017)
- SE1039 [PDF, 92KB] - Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
- SE1606 [PDF, 820KB] - Guidance on the Physician Quality Reporting System (PQRS) 2014 Reporting Year and 2016 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)
- Chapter 29-(T14) -- Independent Rural Health Clinic and Freestanding Federally Qualified Health Center cost Report Form CMS 222-92 (Instructions) [ZIP, 403KB]
- Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019 - See Section III. Other Provisions of the Final Rule - C. Payment for Care Management Services and Communication Technology-Based Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 - See Section III. Other Provisions of the Proposed Rule - A. New Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)
- Previous FQHC Regulations and Other Supporting Information [PDF, 42KB]
FQHC PPS Geographic Adjustment Factors (GAFs)
Frequently Asked Questions
- FQHC Location Identifier - Opens in a new window
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- CfC and CoP: Rural Health Clinic/Federally Qualified Health Center
- Quality, Safety & Oversight - General Information
- Section 10501 of the Patient Protection and Affordable Care Act of 2010, as consolidated and amended through May 10, 2010.
CMS Manuals & Transmittals
How to Stay Informed
- Weekly MLN Connects® for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates
- Rural Health Open Door Forum
- Press Releases - Opens in a new window