These claims will be paid at the FQHC PPS rate until June 30, 2020, … 2. RHC AND FQHC MANUAL MARCH 2020. Federally Qualified Health Centers - Feb. 11, 2020 - EXCEL Federally Qualified Health Centers - Feb. 11, 2020 - PDF • In many cases, these are not the same as the persons who businesses may authorize to sign other types of legal documents on their behalf. The Centers for Medicare & Medicaid Services (CMS) issues a base rate of payment to which the geographic index is applied. Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS) (Rev. Mei WaKwong, JD, Executive Director, CCHP. Medicare Advantage Wrap-Around Payment; Nonphysician Practitioners; Resources. Specific to the PHE, RPM services may be: • Used for physiologic monitoring for chronic and/or acute conditions (e.g., in the case of an acute respiratory virus – pulse and oxygen saturation levels using pulse oximetry) • Furnished to Example of FQHC Claims for Telehealth Services January 27, 2020 through June 30, 2020 . CMS Care Management ; CMS FQHC Center ; CMS PPS . The Prospective Payment System (PPS) rate (rate code 4013) is less any amount for Patient– Centered Medical Home (PCMH) and Recruitment and Retention (R&R) add–ons included in the rate. ORIGINATING SITE FACILITY FEE For CY 2020 the payment amount for HCPCS code Q3014 (the telehealth originating site facility fee) will be 80% of the lesser of the actual charge or $26.56. If the FQHC practitioner should provide services to a hospital patient, these services are not covered under the FQHC benefit. Medicare payment may not be made to a FQHC for services provided to hospital inpatients and outpatients. Beginning July 1, 2020, FQHCs will only be required to submit G2025. FQHC PPS TOB 77X AND ONE OF THE SPECIFIC PAYMENT CODE G0466, G0467, G0468, G0469, G0470 IS PRESENT AND A HCPCS CODE FOR THE QUALIFYING VISIT IS NOT REPORTED ON THE SAME DAY. Please visit the FQHC Center page for more information on understanding the methodology and payment rates for the new FQHC PPS. •RHCs and FQHCs must use HCPCS code G2025, the new RHC/FQHC specific G code for distant site telehealth services, to identify services that were furnished via telehealth beginning on January 27, 2020, the date the COVID-19 PHE became effective. FQHC Specific Payment Code) N/A 052X 99214 (or other FQHC PPS Qualifying Payment Code) 95 052X G2025 95 FQHC Claims for Telehealth Services starting July 1, 2020 Revenue Code HCPCS Code Modifiers 052X G2025 95 (optional) Virtual Communication Services although similar are not considered telehealth services. Description. FQHC Prospective Payment System (PPS) Federally Qualified Health Centers (FQHCs) currently serve over 25 million patients, including more than 12 million (over 1 in 6) people covered by Medicaid. About this guide * This publication takes effect January 1, 2020, and supersedes earlier guides to this program. The files contain the logic used by the FQHC PRICER program to calculate the PPS rate. For telehealth distant site services furnished between January 27, 2020, and June 30, 2020, that are also FQHC qualifying visits, FQHCs must report three HCPCS/CPT codes for distant site telehealth services: the FQHC Prospective Payment System (PPS) specific payment code (GO466, G0467, G0468, G0469, or Beginning July 1, 2020… Section 10501 of the Patient Protection and Affordable Care Act of 2010 modified how payment is made for Medicare services furnished at Federally qualified health centers (FQHCs). Payment … The 2020 base payment rate reflects a 2.2 percent increase above the 2019 base payment rate of $169.77. Modifier 95 may be appended but it is not required. Q2.What services are included in each of the codes? From January 1, 2020, through December 31, 2020, the FQHC PPS base payment rate is $173.50. There is no PC Pricer application for the FQHC PPS at this time. specific-payment-codes.pdf for a list of FQHC PPS specific payment codes). Jan 27, 2020 – Jun 30, 2020: For telehealth distant site services that are also FQHC qualifying visits, FQHCs must report three HCPCS/CPT codes: o the FQHC Prospective Payment System (PPS) specific payment o the HCPCS/CPT code that describes the services furnished via telehealth with modifier 95; o G2025 with modifier 95. o Claims will be paid at the PPS rate and … The coinsurance for FQHC services is 20 percent of the clinic’s … site telehealth services from January 27, 2020 - June 30, 2020, three HCPCS/CPT codes must be reported simultaneously: • the FQHC PPS specific payment code (G0466 - G0470) • the HCPCS/CPT code that describes the service furnished via telehealth with modifier 95 • G2025 with modifier 95 • These claims will be paid at the FQHC PPS rate until June 30, 2020. ü Claims will be paid at the FQHC PPS rate until June 30, 2020, and automatically reprocessed beginning on July 1, 2020, at the $92.03 rate. ü When furnishing services via telehealth that are not FQHC qualifying visits, FQHCs should: – Hold these claims until July 1, 2020, and then – Bill them with HCPCS code … The PPS rate is one facility- specific, predetermined rate, regardless of the allowable RHC or FQHC service. 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