Federally Qualified Health Center (FQHC)

Eligible Distant Site

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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 09/09/2022

FQHCs are not listed as an eligible distant site provider …

FQHCs are not listed as an eligible distant site provider that can deliver services via telehealth.  However, FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. See MLN Guidance for requirements.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (June 6, 2022), (Accessed Sept. 2022).

Medicare pays FQHCs for virtual communication services when an FQHC practitioner provides a patient at least 5 minutes of a billable FQHC communication technology-based or remote evaluation service.

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Jan. 2021, pg. 9 (Accessed Sept. 2021).

See: Federal Medicare Live Video Distant Site

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Alabama

Last updated 11/15/2022

No reference found.

No reference found.

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Alaska

Last updated 11/17/2022

Live Video:

Submitting a claim for a telemedicine service is …

Live Video:

Submitting a claim for a telemedicine service is identical to the way a claim would be submitted for a face-to-face visit. Depending on the method of telemedicine used and the role of the provider in the consultation determines whether a modifier should be added to the procedure code. The role of the provider falls into three categories:

  • Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.

SOURCE: AK Dept. of Health and Social Services, FQHC/RHC (6/12), Accessed Nov. 2022).

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Arizona

Last updated 10/19/2022

Telehealth and telemedicine may qualify as a FQHC/RHC visit if …

Telehealth and telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (7/12/21), pg. 3, (Accessed Oct. 2022). 

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Arkansas

Last updated 10/17/2022

The telemedicine procedure code and procedure codes for ancillary services, …

The telemedicine procedure code and procedure codes for ancillary services, except for family planning-related laboratory procedures listed in this manual, will be denied.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 252.140. Updated Oct. 13, 2003. pg. II-26, (Accessed Oct. 2022).

FQHC Manual refers providers to Telemedicine policy manual for encounters.  AR Medicaid manual does not make an explicit reference to whether or not FQHCs are paid as distant site providers. 

See:  AR Medicaid Live Video Eligible Providers.

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California

Last updated 09/06/2022

Yes, see manual for distant site scenarios and billing/reimbursement policies …

Colorado

Last updated 10/21/2022

For Health First Colorado a billable encounter at an FQHC …

For Health First Colorado a billable encounter at an FQHC is an in person or telemedicine face to face visit with a Health First Colorado member. Telemedicine services are limited to the procedure codes identified on the Telemedicine Provider Information web page at the Provider Telemedicine web page. When a Federally Qualified Health Center provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

SOURCE: CO FQHC & RHC Billing Manual 10/22. (Accessed Oct. 2022).

All distant site rendering providers bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Place of Services codes 02 and 10 can be used during telehealth encounters:

  • POS 02: Telehealth provided other than in the patient’s home. The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
  • POS 10: Telehealth Provided in Patient’s Home. The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Additionally, modifiers FQ and FR can be added to POS 2 and 10:

  • FQ: The service was furnished using audio-only communication technology.
  • FR: The supervising practitioner was present through two-way, audio/video communication technology.

FQHC/RHCs may bill using modifier GT. When used by an FQHC or RHC, the modifier GT identifies the services as being delivered through telemedicine modality. There is no enhanced payment to FQHCs and RHCs when using the modifier GT.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 10/22. (Accessed Oct. 2022).

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Connecticut

Last updated 08/10/2022

FQHCs are listed as eligible providers for a variety of …

FQHCs are listed as eligible providers for a variety of services via telehealth and guidance states that the modifier GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

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Delaware

Last updated 08/24/2022

FQHCs are not explicitly listed as eligible distant site providers, …

FQHCs are not explicitly listed as eligible distant site providers, although the provider list states that other providers can be approved by DMAP. In addition, COVID-19 guidance implies that FQHCs should “continue” typical billing practices for telehealth services as distant site/rendering providers:

  • FQHC Rendering Providers billing for Interactive Telehealth Services or Telephonic Services should continue to bill their appropriate HCPCS (Healthcare Common Procedure Coding System) “G” visit payment code for each payable encounter visit, along with the appropriate code for the service provided and use Place of Service value 02 for all Telehealth Charges. For Telephonic Services, the same codes listed above should be used as appropriate.

SOURCE: DE Medical Assistance Program. Changes to DMMA Telehealth Policies to Respond to COVID-19. April 23, 2020. (Accessed Aug. 2022).

Generally, to receive payment for services delivered through telemedicine technology from DMAP or MCOs, healthcare practitioners must:

  • Act within their scope of practice;
  • Be licensed (in Delaware, or the State in which the provider is located if exempted under Delaware State law to provide telemedicine services without a Delaware (license) for the service for which they bill DMAP;
  • Be enrolled with DMAP/MCOs;
  • Be located within the continental United States;
  • Be credentialed by DMMA-contracted MCOs, when needed;
  • Submit a DMMA Disclosure Form.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 11. (Accessed Aug. 2022).

Explicitly listed eligible distant site providers include:

  • Inpatient/outpatient hospitals (including ER)
  • Physicians (or PAs under the physician’s supervision)
  • Certified Nurse Practitioners
  • Nurse Midwives
  • Licensed Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors of Mental Health
  • Speech Language Therapists
  • Audiologists
  • Other providers as approved by the DMAP

SOURCE: DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.4.3 Telemedicine, pg. 72-73, Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 12. (Accessed Aug. 2022).

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Florida

Last updated 10/26/2022

No Reference Found.

No Reference Found.

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Georgia

Last updated 10/22/2022

Yes – FQHC’s and RHC’s are authorized to serve as …

Hawaii

Last updated 10/29/2022

Providers who are eligible to bill for Hawaii Medicaid services …

Providers who are eligible to bill for Hawaii Medicaid services are also eligible providers who can bill for tele-health.  Refer to Hawaii Provider Manual Chapter 21 FQHCs for list of providers who may provide PPS services.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct. 2022).

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Idaho

Last updated 08/22/2022

No reference found.

No reference found.

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Illinois

Last updated 11/18/2022

The Distant Site is the site where the provider rendering …

The Distant Site is the site where the provider rendering the telehealth service is located. The Distant Site shall be reimbursed as follows:

  • If the Originating Site is an encounter clinic, the Distant Site may not seek reimbursement from the Department for their services. The Originating Site encounter clinic is responsible for reimbursing the Distant Site.
  • If the Originating Site is not an encounter clinic, the Distant Site encounter clinic can seek reimbursement from the Department.

For telemedicine services, the provider rendering the service at the Distant Site can be a physician, podiatrist, advanced practice nurse (APN), or a Physician Assistant (PA) who is licensed by the State of Illinois or by the state where the participant is located. For telepsychiatry services, the provider rendering the service at the Distant Site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program. Telepsychiatry is not a covered service when rendered by an APN or PA. Group psychotherapy is not a covered telepsychiatry service.

SOURCE: Handbook for Encounter Clinic Services. Ch. 200, pg. 17-18.  Aug. 2016. (Accessed Nov. 2022).

An encounter clinic serving as the distant site shall be reimbursed as follows:

  1. If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
  2. If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee as defined in subsection (a)(4) of this Section.

SOURCE: IL Administrative Code 89 140.403 (3). (Accessed Nov. 2022).

See billing examples in appendix.

SOURCE:  IL Dept of Healthcare and Family Services (Sept. 23, 2020). (Accessed Nov. 2022).

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Indiana

Last updated 10/30/2022

When the FQHC or RHC is the distant site, the …

When the FQHC or RHC is the distant site, the service provided by the FQHC or RHC must meet the requirements both for a valid encounter and for an approved telehealth service. The claim must include the following:

  • Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 10, 11, 12, 31, 32, 50 or 72
  • One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient

SOURCE: Indiana Health Coverage Programs, Provider Reference Manual, Telehealth and Virtual Services (Sept. 27, 2022), p. 6. (Accessed Oct. 2022).

Subject to the following criteria, reimbursement is available to FQHCs and RHCS when they are serving as either the distant site or the originating site for telehealth services.

SOURCE: IHCP Bulletin BT 202239 (May 19, 2022), p. 3. (Accessed Oct. 2022).

The office shall reimburse the following Medicaid providers for medically necessary telehealth services:

  • A federally qualified health center
  • A rural health clinic
  • A community mental health center
  • A critical access hospital
  • A home health agency licensed under IC 16-27-1.
  • A provider, as determined by the office to be eligible, providing a covered telehealth service.

SOURCE: IN Admin Code, “Article 5” 405 5-38-4(3) p. 186IN Code, 12-15-5-11 (Accessed Oct. 2022).  

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Iowa

Last updated 10/25/2022

FQHCs may serve as distant sites.

See: IA Medicaid Live

Kansas

Last updated 08/24/2022

The consulting or expert provider at the distant site must …

The consulting or expert provider at the distant site must bill an appropriate code from the list below with place of service (POS) 02 – Telemedicine and will be reimbursed at the same rate as face-to-face services.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-13 (Aug. 2022), (Accessed Aug. 2022).

See: KS Medicaid Live Video Eligible Providers

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Kentucky

Last updated 10/31/2022

For rural health clinics, federally qualified health centers, and federally …

For rural health clinics, federally qualified health centers, and federally qualified health center look-alikes, reimbursement for covered telehealth services and telehealth consultations shall:

  • To the extent permitted under federal law, include an originating site fee in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers if the Medicaid beneficiary who received the telehealth service or telehealth consultation was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike; or
  • If the telehealth service or telehealth consultation provider is employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike, include a supplemental reimbursement paid by the Department for Medicaid Services in an amount equal to the difference between the actual reimbursement amount paid by a Medicaid managed care organization and the amount that would have been paid if reimbursement had been made directly by the department.

SOURCE: KY Revised Statute Sec. 205.559. (Accessed Oct. 2022).

A health-care facility that receives reimbursement under this section for consultations provided by a Medicaid-participating provider who practices in that facility and a health professional who obtains a consultation under this section shall establish quality-of-care protocols, which may include a requirement for an annual in-person or face-to-face consultation with a patient who receives telehealth services, and patient confidentiality guidelines to ensure that telehealth consultations meet all requirements and patient care standards as required by law.

The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall not deny reimbursement for telehealth services covered by this section based solely on quality-of-care protocols adopted by a health-care facility.

SOURCE: KY Statute Sec. 205.559. (Accessed Oct. 2022).

See: KY Medicaid Live Video Eligible Providers

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Louisiana

Last updated 11/08/2022

Reimbursement for service codes appropriate to telemedicine/telehealth will be at …

Reimbursement for service codes appropriate to telemedicine/telehealth will be at the all-inclusive prospective payment rate on file for the date of service (DOS).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Nov. 2022).

See: LA Medicaid Live Video Eligible Providers

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Maine

Last updated 10/18/2022

If approved, FQHCs may serve as the provider site and …

Maryland

Last updated 11/22/2022

FQHCs are permitted places of service from where to deliver …

FQHCs are permitted places of service from where to deliver services via telehealth. All distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice.

SOURCE: MD Medicaid Telehealth Program FAQs. p. 1-2, Updated April 2020. (Accessed Nov. 2022).

The Program shall provide health care services appropriately delivered through telehealth to Program recipients regardless of the location of the Program recipient at the time telehealth services are provided and allow a distant site provider to provide health care services to a Program recipient from any location at which the health care services may be appropriately delivered through telehealth.

SOURCE: MD General Health Code 15-141.2(b). (Accessed Nov. 2022).

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Massachusetts

Last updated 11/18/2022

MassHealth lists specific codes that may be used by community …

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Transmittal Letter CHC-119, p. 6-12 & 6-13, Oct. 2022. (Accessed Nov. 2022).

See: MA Medicaid Live Video Distant Site

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Michigan

Last updated 11/22/2022

A Tribal facility may choose to enroll as a Tribal …

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2122, Oct. 1, 2022 (Accessed Nov. 2022). 

An FQHC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, Oct. 1, 2022 (Accessed Nov. 2022). 

See: MI Medicaid Live Video Distant Site

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Minnesota

Last updated 10/24/2022

Face-to-face service includes telehealth services provided by an eligible provider

Face-to-face service includes telehealth services provided by an eligible provider

SOURCE: MN Department of Human Services, Federally Qualified Health Center and Rural Health Center, Revised Jan. 10, 2022. (Accessed Aug. 2022).

Telehealth visits provided through audio and visual communication or accessible video-based platforms may be used to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health service, 638 tribal clinic, and certified community behavioral health clinic, if the service would have otherwise qualified for payment if performed in person.

SOURCE: MN Statute 256B.0625. (Accessed Oct. 2022).

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Mississippi

Last updated 11/17/2022

The division shall recognize federally qualified health centers (FQHCs), rural

The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement. The division is further authorized and directed to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are appropriately provided by the same organization.

An encounter for face-to-face telehealth services provided by the FQHC acting as a distant site provider. MS Medicaid reimburses a FQHC for both the distant and originating provider site when such services are appropriately provided by the FQHC.

See: MS Medicaid Live Video Distant Site

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Missouri

Last updated 08/19/2022

MO Medicaid allows all licensed health care providers to provide …

MO Medicaid allows all licensed health care providers to provide telemedicine, however FQHCs are not listed explicitly as eligible distant site.

See:  MO Medicaid Live Video Distant Site

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Montana

Last updated 11/01/2022

No direct reference to whether or not FQHCs can be …

No direct reference to whether or not FQHCs can be eligible distant site providers.

See: MT Medicaid Live Video Eligible Providers

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Nebraska

Last updated 11/18/2022

FQHC and RHC payment for telehealth services is the Medicaid …

FQHC and RHC payment for telehealth services is the Medicaid rate for a comparable in-person service. FQHC & RHC core services provided via telehealth are not covered under the encounter rate.

SOURCE: NE Admin. Code Title 471, Sec. 29-004.05, Ch. 29. (Accessed Nov. 2022).

See: NE Medicaid Live Video Distant Site

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Nevada

Last updated 11/03/2022

Facilities that are eligible for encounter reimbursement (e.g. Indian Health

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

See: NV Medicaid Live Video Eligible Providers

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New Hampshire

Last updated 11/10/2022

Not listed as eligible distant site, however there is no …

Not listed as eligible distant site, however there is no restriction on eligible distant sites according to statute.

See: NH Medicaid Live Video Distant Site

SOURCE: NH Revised Statutes 167:4-d (Accessed Nov. 2022).

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New Jersey

Last updated 09/06/2022

For the provision of services, providers are expected to follow …

For the provision of services, providers are expected to follow the same rules they would follow if the patient visit was face-to-face. This includes instances when a license is for an entity such as an independent clinic (which includes FQHC). This license is for a specific address and is not tied to specific personnel. In this instance, the service may only be billed when provided at the address listed on the license. When billed by the clinic, the service provider (for example a physician) may provide services from a remote location but the patient must receive those services while physically present at the independent clinic (licensed location). Independent practitioners have a person specific license that is not tied to a specific address. Services billed by independent practitioners do not have location restrictions. The patient and/or the provider may be at any location as long as the provider is licensed to practice in New Jersey.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2 (Accessed Sept. 2022).

See: NJ Medicaid Live Video Distant Site

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New Mexico

Last updated 10/28/2022

No reference found.

See:  NM Medicaid Live Video Distant Sites

No reference found.

See:  NM Medicaid Live Video Distant Sites

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New York

Last updated 08/25/2022

If a provider who is onsite at an FQHC is …

If a provider who is onsite at an FQHC is providing services via telemedicine to a member who is in their place of residence or other temporary location, the FQHC should bill the FQHC off-site services rate code (4012) and report the applicable modifier (95 or GT) on the procedure code line. If the FQHC is providing services as a distant site provider, the FQHC may bill their PPS rate.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Aug. 2022).

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North Carolina

Last updated 11/03/2022

The distant site is the location from which the provider …

The distant site is the location from which the provider furnishes the telehealth, virtual communications, or remote patient monitoring services. There are no restrictions on distant sites. Distant sites may be wherever the provider may be located. Provider(s) shall ensure that beneficiary privacy is protected (such as taking calls from private, secure spaces; using headsets).

Telehealth is the use of two-way real-time interactive audio and video to provide and support health care services when participants are in different physical locations. Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Centers (RHCs) are considered eligible distant sites and shall follow the coding and billing guidelines in Attachment A below.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, pg. 2, Oct. 1, 2022. (Accessed Nov. 2022).

See: NC Medicaid Live Video Eligible Providers

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North Dakota

Last updated 11/08/2022

While there is an explicit reference to Indian Health Service …

While there is an explicit reference to Indian Health Service facilities or Tribal 638 clinics being reimbursed as an eligible provider, no reference was found for FQHCs.

See: ND Medicaid Live Video Eligible Providers

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Ohio

Last updated 09/07/2022

For a covered telehealth service that is also an FQHC

For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.

There is no limitation on the practitioner or patient site.  FQHCs are listed as eligible billing ‘pay-to’ providers.

See: OH Medicaid Live Video Distant Site

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Oklahoma

Last updated 09/05/2022

Not listed as eligible distant site, according to statute.

See: …

Not listed as eligible distant site, according to statute.

See: OK Medicaid Live Video Distant Site

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Oregon

Last updated 11/10/2022

OR Medicaid requires providers to be enrolled and meet certain …

OR Medicaid requires providers to be enrolled and meet certain requirements.  They also state that the distant site can be any location in which appropriate privacy and confidentiality is ensured, however no explicit reference is made to FQHCs.

See: OR Medicaid Live Video Distant Site

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Pennsylvania

Last updated 09/06/2022

Teledentistry may be used by dentists, FQHCs, and RHCs to …

Teledentistry may be used by dentists, FQHCs, and RHCs to provide dental services to MA beneficiaries. The provider must be licensed in Pennsylvania and enrolled in the MA Program.

FQHCs and RHCs are to continue billing procedure code T1015 with the U9 modifier to indicate dental visits/encounters rendered via teledentistry to patients. FQHCs and RHCs should no longer use the GT modifier, as previously directed in Provider Quick Tip # 237, “Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health  Clinics”(https://www.dhs.pa.gov/providers/QuickTips/Documents/PROMISeQuickTip237.pdf), and must begin using POS 02 as of May 2, 2022.

Teledentistry visits must be provided according to the same standard of care as if delivered in-person.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin, Teledentistry Guidelines and Dental Fee Schedule Updates (May 2, 2022). (Accessed Sept. 2022).

See: PA Medicaid Live Video Distant Site

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Puerto Rico

Last updated 09/08/2022

No reference found.

No reference found.

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Rhode Island

Last updated 10/21/2022

Law requires that all medically necessary and clinically appropriate telemedicine …

Law requires that all medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists and behavioral health providers be reimbursed at a rate not lower than services provided in-person. No explicit reference is made to FQHCs.

See: RI Medicaid Live Video Eligible Providers

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South Carolina

Last updated 08/12/2022

The RHCs and FQHCs would bill an encounter code when …

The RHCs and FQHCs would bill an encounter code when operating as the consulting site. Only one encounter code can be billed for a DOS. Both provider types will use the appropriate encounter code for the service along with the “GT” modifier (via interactive audio and video telecommunications system) indicating interactive communication was used.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 215 (July 2022). (Accessed Aug. 2022).

A consultant site means the site at which the specialty physician or practitioner providing the medical care is located at the time the service is provided via telemedicine. The health professional providing the medical care must be currently and appropriately licensed in South Carolina and located within the South Carolina Medical Service Area (SCMSA), which is defined as the State of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina State border.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30 (July 2022). (Accessed Aug. 2022).

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South Dakota

Last updated 11/10/2022

FQHC/RHCs are eligible to serve as an originating site for …

FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services. A distant site is the physical location of the practitioner providing the service via telemedicine. Please refer to the Telemedicine manual for additional information.

SOURCE: SD Medicaid Billing and Policy Manual, FQHC and RHC Services, June. 2022, (Accessed Nov. 2022).

The following providers can provide services via telemedicine at a distant site:

  • Federally Qualified Health Center (FQHC)

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 (Sept. 2022), (Accessed Nov. 2022),

See: SD Medicaid Live Video Distant Site

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Tennessee

Last updated 09/04/2022

A provider-based telemedicine provider who seeks to contract with or …

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33 .

SOURCE:  TN Code Annotated, Sec. 56-7-1003, (Accessed Sept. 2022).

See: TN Medicaid Live Video Distant Site

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Texas

Last updated 09/07/2022

FQHCs may be reimbursed the distant-site provider fee for telemedicine …

FQHCs may be reimbursed the distant-site provider fee for telemedicine services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

  • FQHC practitioners may be employees of the FQHC or contracted with the FQHC

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 10 (Sept. 2022). (Accessed Sept. 2022).

Telemedicine eligible distant site providers are enrolled as a Texas Medicaid provider and are a:

  • Federally Qualified Health Center (FQHC)

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Sept. 2022) (Accessed Sept. 2022).

See: TX Medicaid Live Video Distant Site

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Utah

Last updated 08/23/2022

Not mentioned explicitly, however state does not have a specific …

Not mentioned explicitly, however state does not have a specific provider list.

See: UT Medicaid Live Video Eligible Providers

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Vermont

Last updated 10/27/2022

A distant site is defined broadly to mean the location …

A distant site is defined broadly to mean the location of a health care provider delivering services through telemedicine at the time the services are provided. However, there is no explicit reference to FQHCs.

See: VT Medicaid Live Video Eligible Providers.

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Virgin Islands

Last updated 09/08/2022

No reference found.

No reference found.

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Virginia

Last updated 11/23/2022

Telehealth services may be included in a Federally Qualified Health …

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), (Oct. 2022) (Accessed Nov. 2022).

See: VA Medicaid Live Video Distant Site

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Washington

Last updated 08/26/2022

FQHCs may receive the encounter rate when billing as a …

FQHCs may receive the encounter rate when billing as a distant site provider if the service being billed is encounter eligible. Clients enrolled in an agency-contracted MCO must contact the MCO regarding whether or not the plan will authorize telemedicine coverage.

SOURCE:  Federally Qualified Health Centers, p. 62. (Aug. 2022), (Accessed Aug. 2022).

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West Virginia

Last updated 09/02/2022

FQHCs may now serve as a distant site for Telehealth …

FQHCs may now serve as a distant site for Telehealth consultations by a psychiatrist or psychologist only and be reimbursed at the encounter rate. The distant-site practitioner must bill the appropriate Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with the appropriate Place of Service on a HCFA1500 form.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019); WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 3 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

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Wisconsin

Last updated 11/21/2022

For the purpose of this Online Handbook topic, FQHC refers

For the purpose of this Online Handbook topic, FQHC refers to Tribal and Out-of-State FQHCs. This topic does not apply to Community Health Centers subject to PPS reimbursement.

FQHCs and RHCs may serve as originating site and distant site providers for telehealth services.

The originating site facility fee is not a FQHC or RHC reportable encounter on the cost report. Any reimbursement for the originating site facility fee must be reported as a deductive value on the cost report.

See: WI Medicaid Live Video Distant Site

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Wyoming

Last updated 10/20/2022

Not explicitly listed on eligible provider list.

See: WY Medicaid

Not explicitly listed on eligible provider list.

See: WY Medicaid Live Video Eligible Providers

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Federally Qualified Health Center (FQHC)

Eligible Distant Site

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