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FQHC/RHC

Date: 12/15/16

Heritage Health (Medicaid):

FQHC/RHC must bill for their services on Form CMS-1450 (UB-04) or electronically using the standard Health Care Claim: Institutional transaction (ASC X12N 837). FQHC/RHC must use the appropriate HCPCS/CPT procedure codes and revenue codes when billing for services.

FQHC/RHC must bill all laboratory/radiology services and other non-FQHC services on the form CMS-1500 (HCFA) or electronically using the standard health care claim; Professional transaction (ASC X12N 837) using the non-FQHC number.

FQHCs must bill for HEALTH CHECKS (Early and Periodic Screening, Diagnosis, and Treatment-EPSDT-Exams) on Form CMS-1500 (HFCA) or electronically using the standard Health Care Claim: Professional transaction (ASC X12N 837).

  • The CPT procedure codes 99381-99385 and 99391-99395 with modifier “EP” must be used to report and claim all HEALTH CHECK and well baby/well child visits on electronic 837 practitioner claims or on Form CMS-1500 (HCFA).
  • Federally Qualified Health Centers must use procedure code T1015 on the first line of the claim for HEALTH CHECK (EPSDT) services on the CMS-1500 (HCFA). Procedure codes for services rendered during the encounter are to be billed on subsequent claim lines (for example, T1015 on line 1, 99383-EP on line 2 and 90707-SL on line 3).