Definition of Visit

A visit is a face-to-face encounter between a center patient and any health professional whose services are reimbursed under the State Plan.

Medical FQHC services shall be billed per “medical encounter”. “Encounter” is defined as a face-to-face visit between a FQHC patient and any health professional whose services are reimbursed under the State Plan for the purpose of diagnosis or treatment. Claims are limited to one all-inclusive “encounter” per day, to include all services received by an eligible recipient on a single day or relevant to the “encounter”. All subsequent services and follow-up care provided by other than a physician, nurse practitioner, or physician’s assistant, ordered as a result of an “encounter” are included in the related “encounter” rate, and are not billed separately.

SOURCE: DE FQHC Policy Manual, 7/1/23, p. 5, 10. (Accessed May 2025).