Same Day Encounters
Reporting encounters for RHCs and FQHCs is limited to one encounter per day per patient. Encounters with more than one health professional or multiple visits with the same health professional on the same day constitute a single visit. The provider may bill up to, but not exceeding, the established encounter rate.
FQHC Provider manual refers providers to Federal Law (Title 42, Subpart X) for definitions specific to FQHCs.
For RHCs and FQHCs that are authorized to bill under the reasonable cost system, encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except when the patient –
- Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day;
- Has a medical visit and a mental health visit on the same day; or
- Has an initial preventive physical exam visit and a separate medical or mental health visit on the same day.
For RHCs and FQHCs that are authorized to bill under the reasonable cost system, Medicare pays RHCs and FQHCs for more than 1 visit per day when the conditions in paragraph (c)(1) of this section are met.
For FQHCs that are authorized to bill under the reasonable cost system, Medicare pays for more than 1 visit per day when a DSMT or MNT visit is furnished on the same day as a visit described in paragraph (c)(1) of this section are met.
For FQHCs billing under the PPS, and grandfathered tribal FQHCs that are authorized to bill as a FQHC at the outpatient per visit rate for Medicare as set annually by the Indian Health Service –
- Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day; or
- Has a medical visit and a mental health visit on the same day.
SOURCE: Code of Federal Regulation, Title 42, Part 405, Sec. 2463, (Accessed Jun. 2025).
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