FQHC billing, or Federally Qualified Health Center billing, is a procedure healthcare professionals use to get paid for services rendered to uninsured or underprivileged patients. Community medical centers and clinics that provide care to low-income people frequently employ this billing method.

The payment rates are a significant distinction between standard medical billing and FQHC billing. FQHCs receive higher reimbursement for preventative and mental health services than traditional physicians. Thus, FQHC patients receive better care.

Because FQHCs are federally funded, medical billing and coding must follow CMS and HRSA standards.

CPT codes for FQHC Billing and coding

Here are a few of the CPT codes that are frequently used in FQHC billing.

99408: Structured screening for alcohol and/or drug misuse and short-term intervention services:

The doctor spends 15 to 30 minutes checking the patient for alcohol or other non-tobacco drug misuse. The doctor then conducts a quick intervention at the same session.

G0402: Initial preventive physical examination; in-person visit; services only available to new beneficiaries for the first 12 months of Medicare enrollment:

This code is primarily used for the first comprehensive preventive visit for people who have just joined Medicare.

G0438–G0439: Medicare enrollees’ yearly wellness visits (AWV):

G0438 is utilized for the initial AWV, while G0439 is used for future AWVs. These codes cover a thorough evaluation and unique preventative strategy for Medicare patients.

99201–99205: The evaluation and management of new patients:

These codes signify various degrees of difficulty and the length of time the practitioner spent diagnosing and treating the patient’s ailment during the appointment.

99211-99215: E/M support for regular patient visits:

These codes are used to report the evaluation and management of existing patients, with varied degrees of complexity and time spent, similarly to the E/M codes for new patients.

99381-99397: Under New Patient:

Preventive medicine treatments for patients of all ages include thorough history-taking, physical examination, counseling, or coordination of care for preventive measures.

90791-90792: Psychological Diagnostic Evaluation Services:

A patient’s mental health condition is initially assessed and evaluated using psychiatric diagnostic evaluation codes. As part of this treatment, the doctor evaluates the patient’s mental health in order to determine a diagnosis. Along with the diagnostic assessment, he also provides several other medical treatments.

99497-99498: Services for advanced care planning:

These codes are employed to document interactions between medical professionals and patients relating to advance directives, healthcare proxies, and end-of-life care planning.

96150–96154: Assessment, intervention, and health and behavior codes:

These codes are utilized to assess and manage health-related behaviors, such as adherence to medical treatment, weight-loss counseling, and smoking cessation counseling.

99487-99489: Management of complex chronic conditions:

These codes are intended to document the non-face-to-face coordination of care and management of patients with chronic illnesses requiring a significant amount of doctor or trained healthcare professional time.

96160-96161: Implementing patient-centered health risk assessment tools, including scoring and documentation:

These codes are utilized to document and understand health risk assessment questionnaire evaluation and scoring.

99441-99443: Telephonic evaluation and management services:

 These codes are used to document phone calls that established patients receive for evaluation and care.

G0511: Services for a Virtual Checkup:

This code is used to document quick, technology-based communications services that a licensed healthcare provider provides to assess and manage the health of a patient remotely.

99495–99496: Services for managing transitional care:

These codes are used to document how care is managed and coordinated for patients moving from an inpatient facility to the community. They entail medication coordination between healthcare professionals, communication between them, and the development of an extensive treatment plan.

99304–99310: Care services offered by nursing homes:

These codes are intended to document evaluation and management services, such as thorough evaluations, medical decision-making, and care coordination, that are given to nursing facility patients.

99401–99404: Prevention counseling and risk factor reduction intervention codes:

These codes are used to record counseling and intervention services for behavioral and lifestyle changes, such as help quitting smoking, advice on diet and exercise, and help with alcohol abuse.

98966–98968: Qualified non-physician healthcare providers offer telephone assessment and management services:

These codes are used to document phone consultations between nurses and other non-physician healthcare practitioners for the purpose of diagnosing and treating patients.

Choose RCM Matter to handle your FQHC billing needs!

Regarding medical billing for FQHC services, RCM Matter is your best option. Our proficiency in FQHC-specific coding and compliance assures proper billing and maximum reimbursement. RCM Matter ensures the best financial results for FQHCs with a certified team that follows coding requirements.

Our dedication to quality enhancement and effective revenue cycle management makes us the perfect partner for optimized billing procedures. With RCM Matter, the right solution for hassle-free medical billing, you can increase your revenue and reduce your workload.

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