Same Day Encounters

An encounter includes all services that day from providers in the same category of service (dental, medical or mental health). This includes when the participant leaves the clinic and returns. Services in the same category from more than one (1) health professional or multiple contacts with the same professional, group education or activities, and all incidental services provided in the same day constitutes a single encounter. For example, if a participant is seen the same day by a physician for a broken leg, has an x-ray, then sees a nurse practitioner for the flu and has a rapid flu test, these would be a single encounter.

If multiple categories of service are provided by the same provider, for example a physician provides a medical encounter for a broken foot and a behavioral health encounter for psychotherapy, these are billed as a single encounter under either the medical or behavioral health benefit depending on the primary diagnosis of the claim. Providers cannot bill both medical and behavioral health encounters in this situation.

Missed appointments, visits to pick up medication, or incidental services on the day of the encounter are not considered a separate encounter. Encounters are limited to two (2) per day for RHCs, and three (3) per day for FQHCs.

An exception to all services provided on the same day being a single encounter is when after the first encounter, the participant suffers a new illness or injury that requires additional diagnosis and treatment that is supported by documentation. For example, the participant came in earlier for the flu and then breaks their leg after leaving the clinic. It would not be a separate encounter if the participant originally came in for a broken leg and the flu. Qualifying additional encounters should be billed with Modifier 59.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Jan. 21, 2026)., p. 14.  (Accessed Mar 2026).