MLN006397 - Federally Qualified Health Center
This revised product comprises Subregulatory Guidance for the Federally Qualified Health Center, and its content is based on publicly available content at https://www.ssa.gov/OP_Home/ssact/title18/1861.htm#act-1861-aa,
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf,
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c09.pdf, and https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf#page=1440. CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates Federally Qualified Health Centers (FQHCs) about billing and payment. This product also includes information on various FQHC topics such as who is considered an FQHC practitioners, Patient Services, Certification, Visits, Payments, Care Management Services, Flu & Pneumococcal Shots, COVID-19 Shots, & COVID-19 Monoclonal Antibody Therapies, Hepatitis B Shot Administration & Payment, Telehealth, Virtual Communication Services, and Consent for Care Management & Virtual Communication Services and includes links to applicable laws, regulations, and compliance information.
Revisions for this product include the following content updates:
• Added advanced primary care management services (page 5)
• New payment rate when you provide 4 or more intensive outpatient program services on the same day (page 5)
• Added specified dental services (pages 5 and 7)
• Federally Qualified Health Center (FQHC) market basket update (page 7)
• Updates to billing for care coordination services (page 9)
• Preventive vaccine billing and payment changes (page 10)
• Coverage of pre-exposure prophylaxis (PrEP) for HIV drugs at FQHCs (page 11)
• Extended some telehealth flexibilities through September 30, 2025 (pages 11, 12, and 14)
• Added coding information for mental telehealth visits (page 14)
The previous version of this Product is currently posted on CMS website at
https://www.cms.gov/files/document/mln006397-federally-qualified-health-center.pdf.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 08, 2025
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.