Wiki FQHC Billing - I am new to FQHC billing


Lake Elsinore, CA
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I am new to FQHC billing and as of 2011 seems there have been alot of changes. Medicare now wants to see CPT codes and no longer just the "roll up" encounter rate. With that being said, should claims include services such as the administration of the flu shots/injections etc? (I know these are reported on the cost report but why are we not billing administration with these codes?)

Also should we be listing Q0091 and G0101 along with the preventative code to Medicare. For some reason I thought I read somewhere that Q0091 and G0101 are not billable codes for FQHC's but I need to verify.

And lastly how are you reporting smoking censation on your bill to Medicare?
Can you bill an E/M code with G0436?

Can someone fill me on how this works? Thank you :)
For FQHC Billing, Medicare wants to see all CPT codes so, yes, you need to show the influenza and the administration codes, even though they are included on the cost report. What you need to do differently for these charges, is not include them in the roll up of your total charges - you exclude them from the roll up because they are paid from the cost report, but you show them on your claim.

FQHC billing guidelines, as you are finding out, are not easily interpreted. It is my understanding that the pap smear and breast exam are part of the all inclusive rate from your E/M code and are not billable.

You can bill smoking cessation in addition to in addition to the E/M code but remember you must append Modifier 25. This is not separately reimbursable, as is DSMT and MNT, but it is considered part of your all inclusive rate. It is rolled up into the total charge and the patient coinsurance will be reflective of this. Also, remember that there is a lot of documentation required by your provider to be able to bill this so make sure your providers are documenting all of the requirements by Medicare if they are going to bill it.