Federally Qualified Health Center (FQHC)

Facility Fee

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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 03/18/2024

FQHCs are listed as an originating site eligible for a …

Alabama

Last updated 02/26/2024

Effective April 1, 2020, Medicaid pays an origination site facility …

Effective April 1, 2020, Medicaid pays an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient and may be billed by all of the providers listed above under Origination Sites (Section 112.2).

No origination site facility fee will be paid for an origination site not listed above. To receive the origination site facility fee, the following must be included on a CMS-1500 or UB-04 claim:

  • FQHCs: Q3014 (independent of the encounter rate)

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).

A recipient’s home should not be considered an origination site entitled to receive an origination site fee

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Jan. 2024, p. 11 (Accessed Feb. 2024).

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Alaska

Last updated 02/27/2024

No facility fee for any entities.

See: AK Medicaid Live

No facility fee for any entities.

See: AK Medicaid Live Video, Facility Transmission Fee

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Arizona

Last updated 02/09/2024

CCHP has found no evidence that AZ Medicaid reimburses a …

CCHP has found no evidence that AZ Medicaid reimburses a telehealth facility/originating site fee for any telehealth entity.

See: AZ Medicaid Live Video Facility/Transmission Fee

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Arkansas

Last updated 02/06/2024

Use procedure code and type of service code Y (paper …

Use procedure code and type of service code Y (paper claims only) to indicate telemedicine charges.

The charge associated with this procedure code should be an amount attributable to the telemedicine service, such as line (or wireless) charges. Medicaid will deny the charge and capture it in the same manner as with ancillary charges.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 262.120. Updated Feb. 1, 2022. pg. II-34, (Accessed Feb. 2024).

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California

Last updated 04/02/2024

FQHCs are not eligible to bill an originating site fee …

FQHCs are not eligible to bill an originating site fee or transmission charges. The costs of these services should be included in the PPS rate, as applicable.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Mar. 2024. Pg. 13. (Accessed Apr. 2024).

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Colorado

Last updated 01/29/2024

FQHCs are eligible for the originating site facility fee and …

FQHCs are eligible for the originating site facility fee and may bill procedure code Q3014 (telemedicine originating site facility fee).

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 1/24. (Accessed Jan. 2024).

See: CO Medicaid Live Video Facility/Transmission Fee

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Connecticut

Last updated 04/12/2024

There is a general prohibition on providers charging a facility …

There is a general prohibition on providers charging a facility fee for telehealth services.

See: CT Medicaid Live Video Facility/Transmission Fee

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Delaware

Last updated 01/15/2024

A facility fee is covered for originating sites. Facility fees …

A facility fee is covered for originating sites. Facility fees for the distant site are not covered. Only one facility fee is permitted per date, per member.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 7/1/23. Sec. 16.6, pg. 79 DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 11. (Accessed Jan. 2024).

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Florida

Last updated 02/23/2024

No Reference Found.

No Reference Found.

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Georgia

Last updated 01/31/2024

FQHCs serving as an originating site may be paid an …

FQHCs serving as an originating site may be paid an originating site facility fee.  FQHCs may not bill for an originating site fee and distant site fee for a telehealth service on the same encounter.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 38 (Jan. 1, 2024).  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23 (Jan. 1, 2024). (Accessed Jan. 2024).

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Hawaii

Last updated 02/13/2024

No reference found.

No reference found.

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Idaho

Last updated 02/13/2024

No reference found.

No reference found.

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Illinois

Last updated 02/27/2024

Telehealth Billing Examples:

Example 1:

Originating Site – Encounter clinic …

Telehealth Billing Examples:

Example 1:

Originating Site – Encounter clinic

Bill the encounter HCPCS Code T1015 and HCPCS Code Q3014, along with any additional appropriate detail code(s). Maximum reimbursement will be the facility’s medical encounter rate.

Reimbursement will be the facility’s medical encounter rate

Distant Site – Encounter clinic

There is no billable service; the Originating Encounter clinic is responsible for payment to the Distant Encounter clinic provider

Example 2:

Originating Site – Encounter clinic

Bill the encounter HCPCS Code T1015 and HCPCS Code Q3014, along with any additional appropriate detail code(s). Maximum reimbursement will be the facility’s medical encounter rate.

Distant Site – Physician’s office/APN/Podiatrist’s Office

There is no billable service; the Originating Encounter clinic is responsible for payment to the Distant Encounter clinic provider

Example 3:

Originating Site – Physician’s office/APN/Podiatrist’s Office

Bill HCPCS Code Q3014

Distant Site – Encounter clinic

Bill the encounter HCPCS Code T1015 and any appropriate detail code(s) with modifier GT on the detail line(s); POS 02. Maximum reimbursement will be the facility’s medical encounter rate. The rendering provider’s name and NPI must also be reported on the claim.

SOURCE: IL Department of Healthcare and Family Services, All Providers Supplement (Sept. 23, 2020). Encounter Clinic Services – Appendices.  (Accessed Feb. 2024).

“Facility Fee” means the reimbursement made to the following originating sites for the telehealth service:  physician’s office, podiatrist’s office, local health departments, community mental health centers, licensed hospital outpatient departments as defined in 89 Ill. Adm. Code 148.25(d) and substance abuse treatment centers licensed by the Department of Human Services-Division of Alcoholism and Substance Abuse (DASA).

A facility fee shall only be paid to providers as defined above. Clinics reimbursed under the prospective payment system shall only be eligible for a medical encounter as set forth in subsection (c)(3) of this Section.

SOURCE: IL Admin. Code Title 89, 140.403 (Accessed Feb. 2024)

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Indiana

Last updated 03/21/2024

When the FQHC or RHC is the originating site (the …

When the FQHC or RHC is the originating site (the location where the patient is physically located), the FQHC or RHC may be reimbursed if it is medically necessary for a medical professional to be present with the member, and the service provided includes all components of a valid encounter code. The claim must include the following:

  • Procedure code Q3014 – Telehealth originating site facility fee, billed with POS code 02 and modifier 95

Separate reimbursement for merely serving as the originating site is not available to FQHCs and RHCs. When the presence of a medical professional is not medically necessary at the originating site, neither the facility fee, as billed by HCPCS code Q3014, nor the facility-specific PPS rate is available, because the requirement of a valid encounter is not met. Pursuant to the Code of Federal Regulations 42 CFR 405.2463, an encounter is defined by the CMS as a face-to-face meeting between an eligible provider and a Medicaid member during which a medically necessary service is performed. Consistent with federal regulations, for an FQHC or RHC to receive reimbursement for services, including those for telehealth, the criteria of a valid encounter must be met.

SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Nov. 1, 2023), p. 6.  (Accessed Mar. 2024).

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 Mar. 2024).

When FQHCs and RHCs bill as an originating site, they must also include procedure code Q3014 – Telehealth originating site facility fee, billed with POS code 02 and modifier 95, on the claim.

SOURCE: IHCP Bulletin BT 202253 (July 14, 2022), p. 1. (Accessed Mar. 2024).

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Iowa

Last updated 01/15/2024

FQHCs and RHCs would not bill Q3014 as a separate

FQHCs and RHCs would not bill Q3014 as a separate service because reimbursement for the related costs would occur through the annual cost settlement process.

SOURCE: Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Jan. 2024).

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Kansas

Last updated 03/04/2024

The originating site, with the member present, may bill code …

The originating site, with the member present, may bill code Q3014 with POS code 50 or 72 under the originating site provider ID and location number.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-14 (Dec. 2023), (Accessed Mar. 2024).

See: KS Medicaid Live Video Facility/Transmission Fee

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Kentucky

Last updated 03/18/2024

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.

SOURCE: KY Revised Statute Sec. 205.559. (Accessed Mar. 2024).

See: Medicaid Live Video Facility/Transmission Fee

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Louisiana

Last updated 02/15/2024

Louisiana Medicaid only reimburses the distant site provider.

SOURCE: LA

Maine

Last updated 02/03/2024

When an FQHC or RHC serves as the Originating (Member) …

When an FQHC or RHC serves as the Originating (Member) Site, the Originating Facility Fee is paid separately from the center or clinic all-inclusive rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 12. (Nov. 6, 2023). (Accessed Feb. 2024).

Also see: ME Medicaid Live Video Facility/Transmission Fee

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Maryland

Last updated 02/21/2024

No explicit reference found.

See MD Medicaid Live Video Facility/Transmission

No explicit reference found.

See MD Medicaid Live Video Facility/Transmission fee:

Reimbursement does not include clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service.

SOURCE: MD Health General Code 15-141.2 (g)(3), (h). & Code of Maryland Admin. Regs. Sec. 10.09.49.07. (Accessed Feb. 2024).

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Massachusetts

Last updated 04/15/2024

Providers may not bill MassHealth a facility claim for originating …

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).

See: MA Medicaid Live Video Facility/Transmission Fee

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Michigan

Last updated 01/19/2024

Allowable originating sites [includes FQHCs] are permitted to submit claims …

Allowable originating sites [includes FQHCs] are permitted to submit claims for the telehealth facility fee. This fee is intended to reimburse the provider for the expense of hosting the beneficiary at their location. To submit this code, the originating site must ensure the technology is functioning, the privacy of the beneficiary is secured, and that the information is shared confidentially

The telehealth facility fee does not qualify as a face-to-face visit and does not generate the PPS Payment.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] & Dept. of Health and Human Services, Medicaid Provider Manual, p. 2146 & 2152, Jan 1, 2024 (Accessed Jan. 2024).

To be reimbursed for the originating site facility fee, the originating site provider must bill the telehealth facility fee. MDHHS will reimburse the originating site provider the current Medicaid fee screen. Additional services provided at the originating site on the same date as the telemedicine service may be billed and reimbursed separately according to published policy.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 270, Jan. 1, 2024 (Accessed Jan. 2024).

See: MI Medicaid Live Video Facility/Transmission Fee

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Minnesota

Last updated 02/29/2024

MN Medicaid does not reimburse a facility fee for any …

MN Medicaid does not reimburse a facility fee for any entity.

See: MN Medicaid Live Video Facility/Transmission Fee

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Mississippi

Last updated 04/05/2024

The Division of Medicaid reimburses a fee per completed transmission …

The Division of Medicaid reimburses a fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. The FQHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate in effect as of January 1, 2021.

SOURCE: MS Admin. Code Title 23, Part 211, Rule. 1.5. (Accessed Apr. 2024).

See: MS Medicaid Live Video Facility/Transmission Fee

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Missouri

Last updated 01/20/2024

RHCs and FQHCs are eligible to receive reimbursement for a …

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 Jan. 2024).

As stated in the Telehealth bulletin, Volume 38 Number 46, dated June 1, 2016, 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). For dates of service on or after July 1, 2016, the originating site reimbursement is increased by 1% and will be the lesser of the usual and customary charge or $15.61.
Effective for dates of service on or after July 1, 2016, FQHC providers must bill no more than $16.97 in order to receive the $15.61 maximum reimbursement. Claims will be subject to post payment review and those reimbursed more than $15.61will 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. 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 Jan. 2024).

See: MO Medicaid Live Video Facility/Transmission Fee

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Montana

Last updated 02/13/2024

FQHCs listed as site eligible for originating site fee in …

FQHCs listed as site eligible for originating site fee in Telemedicine manual.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Feb. 2024).

The following revenue codes are reimbursable when billed by an RHC or FQHC with a valid, allowable procedure code:

  • 0780 – Telehealth originating site

SOURCE: MT Dept. of Public Health and Human Svcs., FQHC and RHC Provider Manual, Nov. 2021, pg. 8 (Accessed Feb. 2024).

See: MT Medicaid Live Video Facility/Transmission Fee.

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Nebraska

Last updated 04/10/2024

Telehealth transmission cost related to non-core services will be the …

Telehealth transmission cost related to non-core services will be the lower of:

  • The provider’s submitted charge; or
  • The maximum allowable amount

The Department will pay for transmission costs for line charges when directly related to a covered telehealth service. The provider must be in compliance with the standards for real time, two-way interactive audiovisual transmissions (see 471 NAC 1-006).

SOURCE:  NE Admin. Code Title 471, Sec. 29-004.05A, Ch. 29, Manual Letter #11-2010, (Accessed Apr. 2024).

See: NE Medicaid Live Video Facility/Transmission Fee

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Nevada

Last updated 03/26/2024

n FQHC may bill for an encounter in lieu of …

n FQHC 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, for example, the originating site and distant site are two different encounter sites, the originating encounter site must bill the telehealth originating Healthcare Common Procedural Coding System (HCPCS) code and the distant encounter site may bill the encounter code. Refer to MSM Chapter 3400 – Telehealth Services

SOURCE: Federally Qualified Health Center Manual, Chapter 2900 (pg. 1), 1/30/24 (Accessed Mar. 2024).

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.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, (Nov. 28, 2023). (Accessed Mar. 2024).

Originating Site: The FQHC may bill an encounter rate in lieu of the originating site fee, if the distant site (provider) is providing ancillary services. The originating site code, Q3014, must be used when billing in lieu of an encounter code.

SOURCE: NV Medicaid FQHC Billing Guidelines. 8/30/19. (Accessed Mar. 2024).

Q3014 is listed as an allowable service for FQHC/CCBHC.

SOURCE: NV Medicaid, FQHC/CCBHC Allowable Services (10/1/23), (Accessed Mar. 2024).

See: NV Medicaid Live Video Facility/Transmission Fee

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New Hampshire

Last updated 03/29/2024

NH Medicaid complies with the Centers for Medicare and Medicaid …

NH Medicaid complies with the Centers for Medicare and Medicaid Service requirements for telehealth. Based on the Medicare requirements, originating sites (including FQHCs) are eligible for a facility fee.

SOURCE: NH Revised Statutes 167:4-d, (Accessed Mar. 2024).

See: NH Medicaid Live Video Facility/Transmission Fee

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New Jersey

Last updated 02/02/2024

All costs associated with the provision of telehealth services, including …

All costs associated with the provision of telehealth services, including but not limited to the contracting of professional services and the telecommunication equipment, are the responsibility of the provider and are not directly reimbursable by NJFC.

No explicit reference to FQHCs.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 4 (Accessed Feb. 2024).

See: NJ Medicaid Live Video Facility/Transmission Fee

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New Mexico

Last updated 02/26/2024

A telemedicine communication fee is paid for the originating site …

A telemedicine communication fee is paid for the originating site at fee schedule rates using the CMS 1500 format; not the encounter rate. The originating clinical service fee is billed at the encounter rate.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Feb. 2024).

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New York

Last updated 03/13/2024

Exceptions to current telehealth payment parity requirements are in place …

Exceptions to current telehealth payment parity requirements are in place for certain costs, including facility fees in instances when such costs were not incurred in the provision of telehealth services because neither the originating nor the distant site occurring within the facility or clinic setting for Article 28 licensed facilities.

When services are provided via telemedicine to a member located at a FQHC opting into APGs, the provider submits an APG claim for services provided. If the off-site provider delivering service is not employed or contracted by the facility, the provider submits APGs for CPT code “Q3014” as originating site fee. See Medicaid Comprehensive Guidance for further site and location billing scenarios.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 8, 15-17. (Accessed Mar. 2024).

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North Carolina

Last updated 03/17/2024

Hybrid Telehealth with Supporting Home Visit

FQHCs, FQHC-Lookalikes, and RHCs …

Hybrid Telehealth with Supporting Home Visit

FQHCs, FQHC-Lookalikes, and RHCs may utilize this hybrid model but shall not bill the home visit codes in table C.1.; FQHCs, FQHC-Lookalikes and RHCs may bill their core service code (T1015) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the beneficiary’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

  • The assistance delivered in the home must be given by an appropriately trained delegated staff person.
  • The fee must be billed for the same day that the home visit is conducted.
  • HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.
  • The core service code (T1015) must be billed separately from the originating site facility fee code (Q3014)

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, Amended Jun. 1, 2023, (Accessed Mar. 2024).

Hybrid Telehealth with Supporting Home Visit: FQHCs and RHCs may bill their core service code (T1015, T1015-HI, or T1015-SC) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the patient’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

  • The assistance delivered in the home must be given by an appropriately trained delegated staff person.
  • The fee must be billed for the same day that the home visit is conducted.
  • HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.
  • The core service code (T1015, T1015-HI or T1015-SC) must be billed as a separate claim from the originating site facility fee code (Q3014).

Telehealth claims, except for hybrid telehealth with supporting home visits, should be filed with the provider’s usual place of service code(s).

Hybrid telehealth with supporting home visits should be filed with Place of Service (POS) 12 (home).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 18,  Aug. 15, 2023. (Accessed Mar. 2024).

See: NC Medicaid Live Video Facility/Transmission Fee

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North Dakota

Last updated 02/19/2024

Revenue code 0780 should only be reported along with Q3014 …

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.

SOURCE: ND Medicaid, Telehealth, Jan. 2024, (Accessed Feb. 2024).

FQHCs and RHCs – Dentistry

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.

SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024).

See: ND Medicaid Live Video Facility/Transmission Fee

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Ohio

Last updated 02/16/2024

Oklahoma

Last updated 03/06/2024

Oregon

Last updated 03/30/2024

OR Medicaid reimburses the facility fee code Q3014 however no …

OR Medicaid reimburses the facility fee code Q3014 however no explicit mention is made to whether or not FQHCs can be reimbursed for it.

See: OR Medicaid Live Video Facility/Transmission Fee

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Pennsylvania

Last updated 01/22/2024

PA Medicaid reimburses a facility fee, however there isn’t an …

PA Medicaid reimburses a facility fee, however there isn’t an explicit indication of whether or not FQHCs are eligible for the fee.

See: PA Medicaid Live Video Facility/Transmission Fee

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Puerto Rico

Last updated 03/22/2024

No reference found.

No reference found.

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Rhode Island

Last updated 02/01/2024

No Reference found

No Reference found

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South Carolina

Last updated 02/08/2024

RHCs and FQHCs are eligible to receive reimbursement for a …

RHCs and FQHCs are eligible to receive reimbursement for a facility fee for the telehealth services when operating as the referring site. Claims must be submitted with the HCPCS code for telehealth referring site facility fee. When serving as the referring site, the RHCs and FQHCs cannot bill the encounter code if these are the only services being rendered.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 215 (Feb. 2024). (Accessed Feb. 2024).

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South Dakota

Last updated 04/02/2024

Telemedicine Originating Site Fee

Reimbursement for the telemedicine facility fee …

Telemedicine Originating Site Fee

Reimbursement for the telemedicine facility fee is limited to the amount listed on the Physician Services fee schedule.

SOURCE: SD Medicaid Billing and Policy Manual, FQHC and RHC Services, Mar. 2024, p. 8 (Accessed Apr. 2024).

The following providers are eligible to be reimbursed a facility fee for serving as an originating site:

  • Federally Qualified Health Center (FQHC)

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3 (Feb. 2024), (Accessed Apr. 2024),

See: SD Medicaid Live Video Facility/Transmission Fee

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Tennessee

Last updated 01/21/2024

A health insurance entity shall reimburse an originating site hosting …

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to the effective date of this act by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Jan. 2024).

See: TN Medicaid Live Video Facility/Transmission Fee

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Texas

Last updated 01/07/2024

Telemedicine Services for FQHCs

FQHCs may be reimbursed the facility

Telemedicine Services for FQHCs

FQHCs may be reimbursed the facility fee (procedure code Q3014) as an add-on procedure code that should not be included in any cost reporting that is used to calculate a PPS or APPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC must submit documentation of medical necessity that indicates that the client needed multiple distant-site provider consultations. An FQHC can use a signed letter from the client’s treating health- care provider at the FQHC to document the client’s medical need for receiving multiple distant-site provider consultations on the same date of service. The letter must state that the client suffered an illness or injury that required additional diagnosis or treatment by a distant-site provider.

If an FQHC is eligible for payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC must submit a claim for the facility fee separate from the claim that was submitted for the encounter.

Distant-Site Telehealth Services for FQHCs

The facility fee (procedure code Q3014) may be reimbursed as an add-on procedure code and should not be included in any cost reporting that is used to calculate a PPS or APPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC must submit documentation of medical necessity indicating that the client needed multiple distant site provider consultations.

An FQHC can use a signed letter from the client’s treating health care provider at the FQHC documenting that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant site provider. This will suffice to document the client’s medical need for purposes of receiving additional facility fee payments for the same client on the same date of service.

If an FQHC is eligible for payment of both an encounter and a facility fee for the same client on the same date of service, the FQHC must submit claims for the facility fee separate from claims submitted for the encounter

SOURCE:  TX Medicaid Telecommunication Services Handbook, (Jan. 2024). (Accessed Jan. 2024).

Healthy Texas Women Program

FQHCs and RHCs may be reimbursed for telemedicine and telehealth in the following manner: …

  • The facility fee (procedure code Q3014) is an add-on procedure code that should not be included in any cost reporting that is used to calculate a FQHC PPS, APPS, or the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

SOURCE: TX Medicaid Healthy Texas Women Program Handbook, (Jan. 2024). (Accessed Jan. 2024).

See: TX Medicaid Live Video Facility/Transmission Fee

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Utah

Last updated 02/28/2024

UT Medicaid does not reimburse a facility fee.

See: UT

UT Medicaid does not reimburse a facility fee.

See: UT Medicaid Live Video Facility/Transmission Fee

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Vermont

Last updated 03/05/2024

Originating site providers may be reimbursed a facility fee using …

Originating site providers may be reimbursed a facility fee using Q3014. However, there is no explicit reference to whether or not FQHCs qualify for this fee.

See: VT Medicaid Live Video Facility/Transmission Fee

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Virgin Islands

Last updated 03/25/2024

No reference found.

No reference found.

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Virginia

Last updated 01/05/2024

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 or originating site and bill under the encounter rate. The encounter rate methodology for FQHCs and RHCs is described in 12VAC30-80-25; the encounter rate for IHCs (including Tribal clinics) is the All Inclusive Rate set by Indian Health Services.

In the event it is medically necessary for a Provider to be present at the originating site at the time a synchronous telehealth service is delivered, said Provider may bill an originating site fee (via procedure code Q3014). Does not explicitly state a FQHC is eligible to bill Q3014.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals), (Oct. 2022) (Accessed Jan. 2024).

See: VA Medicaid Live Video Facility/Transmission Fee

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Washington

Last updated 03/29/2024

FQHCs that serve as an originating site for telemedicine services …

FQHCs that serve as an originating site for telemedicine services are paid an originating site facility fee. Charges for the originating site facility fee may be included on a claim, but the originating site facility fee may not be included on the cost report.

SOURCE: Federally Qualified Health Centers, p. 64-65 (Apr. 2024). (Accessed Mar. 2024).

FQHCs are explicitly listed as an eligible originating site for the facility fee.

SOURCE: RCW 74.09.325; WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 18 (Apr. 2024). (Accessed Mar. 2024).

Originating sites that are enrolled with HCA to provide services to HCA clients and bill HCA may be paid a facility fee for infrastructure and client preparation. HCA does not pay an originating site facility fee to the client in any setting. Additionally, HCA does not pay an originating site facility fee in the following situations:

  • Audio-only telemedicine
  • Store and forward
  • If the originating site is:
    • The client’s home
    • A hospital (inpatient services)
    • A skilled nursing facility o Any location receiving payment for the client’s room and board
    • The same entity as the distant site or if the provider is employed by the same entity as the distant site

FQHCs are instructed to bill for the fee using HCPCS code Q3014.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 17-18 (Apr. 2024). (Accessed Mar. 2024).

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West Virginia

Last updated 02/14/2024

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted …

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted in a 2023 WV Medicaid Provider Newsletter, with the end of the federal Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) have extended telehealth flexibilities until December 31, 2024. West Virginia Medicaid and the WVCHIP will also continue to follow CMS in allowing Telehealth flexibilities until this date. For more information on WV Medicaid COVID Telehealth Policies, see the Medicaid memos located on the WV Medicaid COVID-19 Telehealth Website, and in terms of FQHCs in particular, the Non-emergent E&M visits through Telehealth Memo. In addition, in August 2023 WV Medicaid added an appendix to its Practitioners Services Medicaid Policy Manual Telehealth Section with available codes specific to the PHE Medicaid Telehealth Services Flexibilities – see Policy 519.17 Appendix B.


Enrolled FQHCs or RHCs that serve as an originating site for Telehealth services are paid an originating site facility fee.

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). (Accessed Feb. 2024).

An originating site must bill the appropriate telehealth originating site code (Q3014) unless the originating site is the home of the member. However, facility fees are not covered.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 2 (Effective Jan. 1, 2022). (Accessed Feb. 2024).

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Wisconsin

Last updated 01/09/2024

The originating site facility fee is not a FQHC or

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.

Although federally qualified health centers are not directly reimbursed an originating site fee, HCPCS procedure code Q3014 should be billed for tracking purposes and for consideration in any potential future changes in scope.

SOURCE: WI ForwardHealth Handbook, Originating and Distant Sites, Topic #22739, (Accessed Jan. 2024).

CHCs should submit claims for originating site services on a professional claim form with HCPCS procedure code Q3014 (Telehealth originating site facility fee) and a POS code that represents where the member is located during the service. Modifier GT should not be included with procedure code Q3014 for originating site services to be considered under the PPS reimbursement method. ForwardHealth will not separately reimburse the CHC for originating site services because all costs for providing originating site services have already been incorporated into the PPS rates for CHCs. However, claims billed by CHCs for originating site services may be used for future rate setting purposes, and CHC costs associated with telehealth services may be reported for change in scope adjustment consideration.

SOURCE: WI ForwardHealth Handbook, Telehealth for Community Health Centers, Topic #21997, (Accessed Jan. 2024).

See: WI Medicaid Live Video Facility/Transmission Fee

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Wyoming

Last updated 01/31/2024

Eligible sites that can bill Q3014 (originating site facility fee) …

Federally Qualified Health Center (FQHC)

Facility Fee

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