Medical Service

Federally Qualified Health Center


FQHC is a reimbursement designation from the Bureau of Primary Health Care and CMS

of US department of health and human services.

  • Provider based FQHC bill under parent provider.
  • Medicare Part B Deductible does not apply for FQHC services.
  • Billed encounter rate.
Major CPT:
 G0466 New patient one on one visit with FQHC practitioner
 G0467 Established patient one on one visit with FQHC practitioner
 G0468 IPPE or AWV : Initial Preventive Physical Examination / Annual Well Visit
 G0469 Mental health new patient
 G0470 Mental health established patient

In FQHC billing, the appropriate Medicare G code for E & M services and the Medicaid’s T1015 usage is critical for obtaining revenue from these payers.

G codes are never billed to the secondary.

Medicare is never a secondary payer for patients who receive care from FQHC.

FQHC practitioners are
  • Physician
  • NP (Nurse Practitioners)
  • PA (Physician Assistant)
  • CNM (Certified Nurse Midwife)
  • CP (Clinical Psychologist)
  • CSW (Clinical Social Worker)
FQHC Services include:
  • Face to face medical or mental health services
  • Advance care planning
  • Chronic care management
  • Principal care management
  • Transitional care management
  • Hepatitis C screenings
  • IPPE and AWV
  • Screening mammography
  • Screening pap smear and pelvic exam
  • Prostrate & Colorectal cancer screening
  • Diabetes screening
  • Bone mass management
  • Cardiovascular screening blood tests
  • Venipuncture when rendered at FQHC
  • Ultrasound screening for abdominal aortic aneurysm
  • Prenatal and Perinatal services

ACP – Advance Care Planning is considered a face to face service between a practitioner and a patient on advance directives and it is a stand-alone billable FQHC visit.

If an ACP is rendered on the same day as the AWV it is considered a preventive service and must be reported with Modifier 33.

From January 1, 2022 through December 31, 2022, the FQHC PPS base payment rate is $180.16. The 2022 base payment rate reflects a 2.1 percent increase above the 2021 base payment rate of $176.45.

For additional information, please contact us at +1440-209-5122 or