1. D

    Wiki FQHC - Depo Provera and E&M

    I am looking for clarification on billing for an Office Visit and Depo Provera injection on the same day. I know that you can bill the OV, drug and injection for a New Patient when all elements of the E&M are met or even for an Existing Patient when they are being seen for Birth Control...
  2. C

    Question Billing for Acupuncture Services rendered in an FQHC

    Can you bill Medicare Part A under the facility for acupuncture services rendered in an FQHC? If so, can you please provide me with your source? If not, do you have a different solution? See below for the question from my biller. I’m trying to get more information on billing acupuncture...
  3. M

    Question No Surprises Act good faith estimate for walk-ins

    From what I understand, as an FQHC we have to provide our self pay patients an estimate at least one day before their service, but we often get walk-ins and same day appointments. How are we supposed to abide by this law when we have patients coming in the same day the appointment is scheduled...
  4. M

    Wiki New to FQHC billing

    Our outpatient medical clinic recently became a FQHC. I have been tasked with figuring out what this means for our billing practices, but I have no idea where to begin because this is something I know nothing about. We have been using the CMS 1500 forms for years, but is there a specific form...
  5. B

    Wiki Billing for Metered Dose Inhaler & Drug In Office

    Hello, I code for a small pediatric clinic that is part of a larger FQHC facility (in case that makes a difference). Our pediatricians will on occasion give Flovent or Advair through a metered dose inhaler to a patient who is having asthma exacerbation. I have a few questions: 1. Is 94640...
  6. R

    Wiki FQHC Rules

    I am trying to help out a friend with some audits. However, I have never audited for a FQHC. Where is the best place to see all the rules for what they can and cannot charge? Thank you
  7. S

    Wiki FQHC and Revenue codes

    We are a FQHC and have been getting denials from Medicare stating that the revenue codes are invalid or missing. Here is one example. We are currently billing the 0521 revenue code for our 99213 and a 0636 revenue code for J1885. Should the J1885 be billed for the 0521 as well? Any help or...
  8. K

    Wiki Medicare: Telephone Visit Guidelines & Referrals

    I believe I have a comfortable grasp on what can be coded during the COVID-19 changes for my FQHCs but I'm running into a semantics issue and would love some input. Normally there would be a medical service for multiple conditions and some of those may be referred to other specialists. A common...
  9. M


    I work for a Tribal FQHC and have some questions regarding procedures not associated with a G code under FQHC guidelines. It has been our directive to split out the procedure codes (for example I&D, wart removal, etc) and submit those to Medicare B. However, when I am researching FQHC...
  10. K

    Wiki Pharmacist Options - CHC

    I work for an FQHC/CHC and they are trying to catch missed revenue. I know a Pharmacist only encounter is 99211 (nonbillable in our setting). However, if they implement a process where the Pharmacist initiates the visit like a RN would and then leaves the MDM to the provider for completion...
  11. F

    Annual Wellness visits at FQHC and RNs

    Can RN's perform a majority or part of the AWV as long as the provider approves of the screening and education pieces, and also sees the patient? Any advice on how to implement Annual Wellness Visits in our practice without requiring an hour of the provider's time?
  12. J

    billing for delivery DR didn't attend?

    I am at an FQHC Indian Health Facility for general family practice. One of my new providers who will be providing OB care is wanting me to bill for a delivery that she was not present for. I have never done OB coding or billing before but it seems wrong to me. Apparently she is part of a group...
  13. J

    Wiki Medicare Annual Wellness Visit and additional Well Woman Exam

    Hello, fellow coders: One of my providers performed an AWV and a separate well woman exam on two different dates of service. Since both were preventive, triggering use of G0468 (we're an FQHC), Medicare paid the first well woman visit, but denied the AWV. My billing manager wants the...
  14. E

    Wiki FQHC Seminar

    I am new to FQHC billing and am looking for a basic seminar/training that will walk me through the process and set up for billing purposes. Links would be helpful... Thanks!!
  15. Y

    FQHC Dual encounters, what constitutes "significant additional work"

    When working pediatric notes, as an FQHC we are allowed to bill for a dual visit "whenever a problem or abnormality (i.e., exercise-induced asthma, migraine headaches, otitis media, prescription management) is addressed and requires significant additional work to perform the required key...
  16. L

    Wiki help with coverage for 11055/11056/11057 for straight Medicare

    Hello all, I'm still new to Podiatry billing. I work at a FQHC. For pts without a systemic disease, will the M codes for pain in foot/toes, or difficulty walking (R26.2) assist with straight Medicare coverage if these dx are appropriate? Laura
  17. D

    Wiki FQHC Billing and Clia waived testing.

    Can anyone tell me if they are billing CLIA waived tests at their health centers? I know they are included in the "encounter rate" for Medicare and will go on the cost report to recoup our costs. However for all other insurances are you/can you bill the limited CLIA waived tests using the QW...
  18. W

    Wiki FQHC billing/services question

    Hello- I am writing from a clinic that is about to merge with a FQHC look alike. We will begin billing under the FQHC look alike's status and will receive the PPS rate for eligibile visits. Probably not necessary to say, but I have questions around what this looks like from a billing &...
  19. F

    Wiki * CNM Prolonged Services *

    I work at a FQHC organization and we have a CNM who spends prolonged hours with a patient. She is in attendance at all times, but does not deliver, only monitoring. My question is as an FQHC, are we allowed to charge for prolonged services because she does not get reimbursement for the delivery...
  20. T

    Wiki Billing 96152

    We are an FQHC in Arizona. We have an LCSW. We need to bill 9615x codes but keep getting denied saying a modifier is missing. Example: T1015 FQHC Visit 96152 Health and Behavioral intervention, each 15 minutes, face-to-face, individual Anyone know what modifier we would use? Thanks, Theresa...
  21. M

    Wiki FQHC Billing

    Can anyone provide me with an overview of billing for a FQHC.
  22. T

    Wiki FQHC - Anitcoagulation Management 99363-99364

    Is an FQHC facility allowed to bill the anticoagulation management codes 99363 and 99364? If yes do you bill Medicare B?
  23. C

    Wiki Medicare case/care management

    Hello! We have case/care managers at our office that use the G9001 and G9002 for Coordinated care fee, initial rate, and coordinated care fee maintenance rate. With Medicare, they do not accept these codes, and do not pay anything on them. I am wondering if there is a different way to bill these...
  24. D

    Wiki Coding for Hospice patient when provider is not the Hospice provider

    We had a patient come in to our office that is a Hospice patient in another location. He was seen for several problems unrelated to his hospice diagnosis. The provider also mentioned his terminal diagnosis in the progress note. Can I bill this with a condition code 07? For treatment of...
  25. C

    Wiki FQHC new billing rules

    Has anyone billed 2011 services with a clinic rate and gotten paid? Am curious on your take on the new rules.