CMS Pub. 100-04, ch. 4, § 280

Qualified Health Centers (FQHCs) Billing for Non RHC/FQHC

Services

(Rev. 3941; Issued: 12-22-17; Effective: 01- 01-18; Implementation: 01-02-18)

A-01-93, A-03-066

Hospitals sometimes operate hospital based RHCs or FQHCs. Prior to implementation of

outpatient PPS, hospital based RHCs/FQHCs were permitted to include both RHC/FQHC

and non-RHC/FQHC services on the same claim, under the RHC/FQHC bill type, with

appropriate revenue codes.

Beginning with the implementation of OPPS, non-RHC/FQHC services provided by the

hospital based RHC/FQHC, including RHCs/FQHCs that are parts of CAHs or other

exempted or excluded (from OPPS) hospitals, must be billed under the host hospital’s

provider number, using hospital billing procedures and bill types. These services are not

covered or paid as RHC/FQHC services but instead may be covered hospital outpatient

services and paid under the applicable methodology for the hospital.

The RHC/FQHC services remain subject to the encounter rate payment methodology and

are billed using the RHC/FQHC provider number, bill type and revenue codes.

See the Medicare Benefit Policy Manual for a description of covered RHC/FQHC

services.

See chapter 9, in this manual for billing instructions for provider based and independent

RHC/FQHC services.