Facility Fee

RHCs and FQHCs are eligible to receive reimbursement for a facility fee for Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee). Reimbursement will be made at the lesser of the actual charge or $14.75. FQHCs will be reimbursed at 92% of their billed charges up to a maximum payment of $14.75.

Effective for dates of service on or after January 1, 2016, FQHC providers must bill no more than $16.03 to receive the $14.75 reimbursement.  Claims will be subject to post payment review and those reimbursed more than $14.75 will be adjusted to recoup the difference.

FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.

FQHCs must remove charges and payments for Telehealth services from their year-end cost reports.

SOURCE: Provider Bulletin Volume 38, No. 46, June 1, 2016, (Accessed Apr. 2025).

FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge. FQHC providers must also remove charges and payments for Telehealth services from their year-end cost reports.

SOURCE: Provider Bulletin Volume 39, No. 28, Nov. 9, 2016, (Accessed Apr. 2025).

Federally Qualified Health Centers

• FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.

  FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.

FQHC Cost Report

• The telemedicine charges and costs, including the depreciation cost for equipment, are not allowed on the FQHC cost report.
• FQHC providers must remove charges and payments for telemedicine services from their year-end cost reports.

See originating and distant site scenario examples in Reimbursement Scenarios document.

SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Apr. 2025).

See: MO Medicaid Live Video Facility/Transmission Fee