Facility Fee

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

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m). (Accessed Feb. 2023).

See: Federal Medicare Live Video Facility/Transmission Fee

FQHCs should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

SOURCE: AL Medicaid Alert, Origination Site Facility Fee, Mar. 13 ,2020, (Accessed Feb. 2023).

No facility fee for any entities.

See: AK Medicaid Live Video, Facility Transmission Fee

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

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 Jan. 2023).

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. Jan. 2023. Pg. 12. (Accessed Feb. 2023).

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

See: CO Medicaid Live Video Facility/Transmission Fee

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 10/22. (Accessed Jan. 2023).

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

See: CT Medicaid Live Video Facility/Transmission Fee

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, 10/28/22. Ch. 16 Telemedicine, Sec. 16.2,4.2 16.2.5.3 & 16.8.3, pg. 72-76 & DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 11. (Accessed Feb. 2023).

DC Medicaid does not reimburse for a telemedicine transaction fee and/or facility fee.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.28, Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5, Physicians Billing Manual.  DC Medicaid.  (Jan. 2023) Sec. 15.8. P. 54, Clinic Billing Manual, DC Medicaid (Jan. 2023), Sec. 15.8, P. 52. FQHC Billing Manual, DC Medicaid 15.6,2 P. 54. (Jan. 2023), Behavioral Health Billing Manual (Jan. 2023) 14.8, p. 70., Outpatient Hospital Billing Guide, 16.8, p. 78 (Jan 2023), Inpatient Hospital Billing Guide, 11.8, p. 62 (Jan. 2023), Long-Term Care Billing Manual, 15.8, p. 54 (Jan 2023).  (Accessed Feb. 2023).

No Reference Found.

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. 42 (Jan 1, 2023). Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23. (Jan 1, 2023). (Accessed Jan. 2023).

When a spoke or originating site is solely used to facilitate tele-health, payment for the facilitation shall not exceed the published Medicare rate for transmission services for spoke sites.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Jan 2023).

No reference found.

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. 2023).

“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. 2023)

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 (Sept. 27, 2022), p. 6.  (Accessed Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

SOURCE: Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Jan. 2023).

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, 8-13 (Aug. 2022), (Accessed Feb. 2023).

See: KS Medicaid Live Video Facility/Transmission Fee

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 Feb. 2023).

See: Medicaid Live Video Facility/Transmission Fee

Louisiana Medicaid only reimburses the distant site provider.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22). (Accessed Jan. 2023).

See: LA Medicaid Live Video Facility/Transmission Fee

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. 13 (June 15, 2020). (Accessed Jan. 2023).

Also see: ME Medicaid Live Video Facility/Transmission Fee

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. 10.09.49.09(G). (Accessed Jan. 2023).

No reference found.

See: MA Medicaid Live Video Facility/Transmission Fee

To be reimbursed for the originating site facility fee, the originating site provider must bill the appropriate telemedicine procedure code and modifier. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 268, Oct. 1, 2022 (Accessed Nov. 2022).

FQHCS are eligible originating sites.

See: MI Medicaid Live Video Facility/Transmission Fee

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

See: MN Medicaid Live Video Facility/Transmission Fee

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 Mar. 2023).

See: MS Medicaid Live Video Facility/Transmission Fee

No reference found explicit to FQHCs.  Procedure code Q3014 is reimbursed, as referenced in the Physician manual.

See: MO Medicaid Live Video Facility/Transmission Fee

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 Jan. 2023).

See: MT Medicaid Live Video Facility/Transmission Fee.

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 Mar. 2023).

See: NE Medicaid Live Video Facility/Transmission Fee

An 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.5, (Accessed Feb. 2023).

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 Facility/Transmission Fee

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 & Centers for Medicare and Medicaid Services. Medicare Learning Network Booklet, p. 5. (June 2021). (Accessed Feb. 2023).

See: NH Medicaid Live Video Facility/Transmission Fee

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 Nov. 2022).

See: NJ Medicaid Live Video Facility/Transmission Fee

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. 2023).

When services are provided via telemedicine to a patient located at an FQHC originating site, the originating site may bill only the FQHC offsite services rate code (4012) to recoup administrative expenses associated with the telemedicine encounter. When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the FQHC originating site, the originating site may bill the Prospective Payment System (PPS) rate in addition to the FQHC offsite services rate code (4012).

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Feb. 2023).

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).

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, pg. 19 Dec. 1, 2020. (Accessed Feb. 2023).

Any Medicaid enrolled provider who provides a beneficiary with access to audio and visual equipment in order to complete a telehealth encounter may bill for a facility fee when their office or facility is the site at which the beneficiary is located when the service is provided and the distant site provider is at a different physical location.

See: NC Medicaid Live Video Facility/Transmission Fee

Facility fee only available to service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility.  No direct reference to FQHCs is made.

See: ND Medicaid Live Video Facility/Transmission Fee

No reference found

See: OH Medicaid Live Video Facility/Transmission Fee

No reference found

See: OK Medicaid Live Video Facility/Transmission Fee

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

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

No reference found.

No Reference found

RHCs and FQHCs are eligible to receive reimbursement for a facility fee for the telemedicine services when operating as the referring site. Claims must be submitted with the HCPCS code for Telemedicine originating 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 (Oct. 2022). (Accessed Feb. 2023).

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, Nov. 2022, p. 8 (Accessed Mar. 2023).

See: SD Medicaid Live Video Facility/Transmission Fee

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 Dec. 2022).

See: TN Medicaid Live Video Facility/Transmission Fee

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

See: TX Medicaid Live Video Facility/Transmission Fee

UT Medicaid does not reimburse a facility fee.

See: UT Medicaid Live Video Facility/Transmission Fee

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

No reference found.

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 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 Facility/Transmission Fee

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. 72-73 (Jan. 2023). (Accessed Feb. 2023).

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. 17 (Jan. 2023). (Accessed Feb. 2023).

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. Originating site facility fees are not paid for audio-only or store-and-forward telemedicine services. Facility fees are available for originating sites, except hospitals (inpatient services), skilled nursing facilities, homes or other locations receiving payment for the client’s room and board. HCA does not pay an originating site facility fee if the site is part of the same entity as the distant site or if the provider is employed by the same entity as the distant site, nor does HCA pay an originating site facility fee to the client in any setting.

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. 16-17 (Jan. 2023). (Accessed Feb. 2023).

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. 2023).

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. 2023).

See: WI Medicaid Live Video Facility/Transmission Fee

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

• Federally Qualified Health Center (FQHC)

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 133 &135 (Jan. 1, 2023), WY Division of Healthcare Financing Tribal Provider Manual, pg. 145 & 224 (Jan. 1, 2023) & Institutional Provider Manual pg. 139 & 142.  (Jan. 1, 2023). (Accessed Jan. 2023).

See: WY Medicaid Live Video Facility/Transmission Fee