Federally Qualified Health Center (FQHC)

Home Eligible

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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

FQHC services are covered when provided in outpatient settings only, …

FQHC services are covered when provided in outpatient settings only, including a patient’s place of residence, which may be a skilled nursing facility or a nursing facility, other institution used as a patient’s home, or are hospice attending physician services furnished during a hospice election.

FQHC services are not covered in a hospital, as defined in section 1861(e)(1) of the Act.

SOURCE: Code of Federal Regulation, Title 42, Sec. 405.2446, (Accessed Sept. 2022).

FQHC visits may take place:

  • In the FQHC
  • At the patient’s home, including an assisted living facility
  • In a Medicare-covered Part A skilled nursing facility (SNF)
  • At the scene of an accident

FQHC visits can’t take place at:

  • An inpatient or outpatient hospital department, including a critical access hospital (CAH)

A facility with specific requirements excluding FQHC visits

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Jan. 2021, pg. 6 (Accessed Sept. 2021).

Visiting nurse services is covered under the following circumstances:

  • The RHC or FQHC is located in an area in which the Secretary has determined that there is a shortage of home health agencies.
  • The services are rendered to a homebound individual.
  • The services are furnished by a registered professional nurse or licensed practical nurse that is employed by, or receives compensation for the services from the RHC or FQHC.
  • The services are furnished under a written plan of treatment. See regulation for more details.

SOURCE: Code of Federal Regulation, Title 42, Sec. 405.2416, (Accessed Sept. 2022).

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Alabama

Last updated 11/15/2022

Home Health services are excluded as an FQHC service because …

Home Health services are excluded as an FQHC service because home health services are available on a state wide basis.

The following place of service codes apply when filing claims for FQHCs:

  • (12) Home

SOURCE: AL Medicaid, Ch. 15 Alabama FQHC Manual, Oct. 2022, p. 16-5, (Accessed Nov. 2022).

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Alaska

Last updated 11/17/2022

Alaska Medicaid covers services provided away from the FQHC/RHC site …

Alaska Medicaid covers services provided away from the FQHC/RHC site in the following situations

  • An FQHC physician, physician assistant, or advanced nurse practitioner providing services in a nursing facility

Services provided off-site are also covered when provided to a homebound recipient under the following conditions:

  • The United States Department of Health and Human Services determines there is a shortage of home health agencies in the recipient’s home community
  • Services are provided by a registered nurse, a licensed practical nurse, or a licensed vocational nurse who is employed by or receives compensation for the services from the clinic
  • Services are approved under a written plan of care
    •  established by a supervising physician, physician assistant, or advanced nurse practitioner and reviewed every 60 days by a supervising physician
    •  signed by the advanced nurse practitioner, physician assistant, or supervising physician
    • Services are limited as per 42 C.F.R. 405.2416(b-c)

Alaska Medicaid considers recipients homebound if they are confined to their home due to a medical or health condition. Recipients in inpatient hospitals or long-term care facilities are not considered homebound.

SOURCE: AK Dept. of Health and Social Services, FQHC/RHC, Services Provided Off Site (10/2017), Accessed Nov. 2022).

The department will pay the following providers for the following home health services:

  • a public or private organization that meets the requirements of (a) of this section may provide comprehensive home health services identified in 7 AAC 125.310(a);
  • a rural health clinic or federally qualified health center enrolled under 7 AAC 140.200 may provide limited home health care services identified in 7 AAC 125.310(a)(2).

SOURCE: AK Admin Code Title 7, Sec. 125.300, (Accessed Aug. 2022). 

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Arizona

Last updated 10/19/2022

No reference found.

No reference found.

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Arkansas

Last updated 10/17/2022

FQHC services furnished off-site are covered under the FQHC benefit …

FQHC services furnished off-site are covered under the FQHC benefit when the employed practitioner of the FQHC furnishes the services on behalf of the FQHC or when the FQHC practitioner’s agreement with the FQHC requires that he or she provide the services and seek compensation from the FQHC.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 212.300. Updated Oct. 13, 2003. pg. II-10, (Accessed Oct. 2022).

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California

Last updated 09/06/2022

Established Patient – A Medi-Cal eligible recipient who meets one …

Established Patient – A Medi-Cal eligible recipient who meets one or more of the following conditions:

  • The patient has a health record with the FQHC that was created or updated during a visit that occurred in the clinic or during a synchronous telehealth visit in a patient’s residence or home with a clinic provider and a billable provider at the clinic. The patient’s health record must have been created or updated within the previous three years.
  • The patient is homeless, homebound or a migratory or seasonal worker (HHMS) and has an established health record that was created from a visit occurring within the last three years that was provided outside the originating site clinic, but within the FQHC’s service area. All consent for telehealth services for these patients must be documented.
  • The patient is assigned to the FQHC by their Managed Care Plan (MCP) pursuant to a written agreement between the plan and the FQHC.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Aug. 2020. Pg. 11. (Accessed Sept. 2022).

FQHC manual refers to fee-for-service policy for the definition of an ‘originating site’:

“Originating site” means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates. For purposes of reimbursement for covered treatment or services provided through telehealth, the type of setting where services are provided for the patient or by the health care provider is not limited (Welfare and Institutions Code [W&I Code], Section 14132.72[e]). The type of setting may include, but is not limited to, a hospital, medical office, community clinic or the patient’s home.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2. (Accessed Sept. 2022).

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Colorado

Last updated 10/21/2022

Generally, the manual states that services can be provided via …

Generally, the manual states that services can be provided via telemedicine between a member and a distant provider when a member is located in their home or other location of their choice. General modifier instructions for all distant site providers, which includes FQHCs/RHCs, include POS 10 references.

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

Billable services for FQHCs shall include core and noncore services …

Billable services for FQHCs shall include core and noncore services identified in section 17b-262-997 of the Regulations of Connecticut State Agencies. Covered core and noncore services shall be billed on an encounter basis in accordance with section 17b-262-1002 and are subject to the following limitations:

Billable encounters shall include encounters that:

  1. Take place at a service site approved by HRSA as part of a FQHC; or
  2. Take place in a patient’s home for the purpose of providing services to FQHC patients; and
  3. Are documented in the patient health records.

The services of a registered nurse may be billed as a medical encounter unless provided incident to a medical encounter as described below. Encounters with more than one health professional for the same type of service (e.g., a nurse and a physician provide a medical encounter) and multiple interactions with the same health professional that take place on the same day constitute a single encounter except when the patient, after the first interaction, suffers illness or injury requiring additional diagnosis and treatment.

SOURCE: CT FQHC Provider Manual, p. 9 (Oct. 1, 2020) (Accessed Aug. 2022).

Guidance for eligible providers, including FQHCs, 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

Generally, an approved originating site may include the DMAP member’s …

Generally, an approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized. A patient’s home is an eligible originating site but must comply with HIPAA, privacy, secure communications, etc., and does not warrant an originating site fee.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 73 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1. 8. pg. 11 & 12. (Accessed Aug. 2022).

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District of Columbia

Last updated 09/03/2022

The beneficiary’s home, or other settings authorized by DHCF, may …

The beneficiary’s home, or other settings authorized by DHCF, may serve as the originating site. When the originating site is the beneficiary’s home the distant site provider is responsible for ensuring that the technology in use meets the minimum requirements set forth in Subsection 910.13.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.7 & 910.30. (Accessed Sept. 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

A FQHC or RHC visit may take place in the …

A FQHC or RHC visit may take place in the FQHC or RHC, the patient’s residence, an assisted living facility, a Medicare-covered Part A SNF (see Pub. 100-04, Medicare Claims Processing Manual, chapter 6, §20.1.1), or the scene of an accident.

Qualified services provided to a FQHC or RHC patient in a location other than the FQHC or RHC facility are considered FQHC or RHC services if:

  • the practitioner is compensated by the FQHC or RHC for the services provided;
  • the cost of the service is included in the FQHC or RHC cost report; and
  • other requirements for furnishing services are met.

Except for hospital settings, services furnished in a location other than the FQHC or RHC (either during the posted hours of operation or during another time), and services furnished to FQHC or RHC patients (either those seen previously in the FQHC or RHC or those not previously seen), are billed as a FQHC or RHC visit when the FQHC or RHC includes the practitioner’s compensation for these services in the FQHC or RHC cost report and other certification and cost reporting requirements for furnishing services are met. If the cost of a service is not included on the FQHC or RHC cost report, the service may be billed to Part B if appropriate. Only compensation paid for FQHC or RHC services can be claimed on the cost report.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 8-9. (Oct 1, 2022). (Accessed Oct. 2022).

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Hawaii

Last updated 10/29/2022

PPS will be paid as follows:

When the patient is …

PPS will be paid as follows:

When the patient is at the spoke/originating site, that is a FQHC (or their residence), and the provider of FQHC services is at the hub/distant site where the service is performed, which is also a FQHC, the hub/distant site will be paid PPS.

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

Originating site means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider’s office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient’s home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of the patient.

SOURCE: HI Revised Statues Section 346-59.1(g). (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

No reference found.

No reference found.

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Indiana

Last updated 10/30/2022

To align with national updates by the Centers for Medicare …

To align with national updates by the Centers for Medicare & Medicaid Services (CMS), the IHCP revised the description for POS 02 and authorized the use of POS code 10. For dates of service on and after July 21, 2022, the IHCP requires the use of POS 02 or 10 for telehealth services, including for FQHCs and RHCs.

SOURCE: Indiana Health Coverage Programs, Provider Reference Manual, Telehealth and Virtual Services (Sept. 27, 2022), p. 3.  (Accessed Oct. 2022).

IHCP will allow the use of POS code 10 for federally qualified healthcare centers (FQHCs) and rural health clinics (RHCs) for dates of service (DOS) on or after July 21, 2022.

Any FQHC or RHC claims with DOS before July 21, 2022, will deny if the POS 10 is present on the claim. Please correct these claims using the appropriate POS 02 and resubmit. The definitions for the telehealth POS codes changed on Jan. 1, 2022:

  • POS 02 – Telehealth provided other than in patient’s home
  • POS 10 – Telehealth provided in patient’s home

SOURCE: IHCP Bulletin BT 202253 (July 14, 2022). (Accessed Oct. 2022).

The IHCP reimburses FQHCs and RHCs for services to homebound individuals only in the case of FQHCs and RHCs located in areas with shortages of home health agencies, as determined by the FSSA.

SOURCE: IHCP Federally Qualified Health Centers and Rural Health Clinics Provider Reference Module (Jan 1, 2022, published May 19, 2022), p. 3. (Accessed Oct. 2022).

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Iowa

Last updated 10/25/2022

FQHC services are provided to members who are patients of …

FQHC services are provided to members who are patients of the center. Therefore, these services are reimbursable when furnished to a member at the center, at a hospital or other medical facility, or at the member’s place of residence, when the physician is compensated for the services by the center.

Physician Services

Covered services performed by a physician outside the center, including services to members in an inpatient hospital, are also covered FQHC services if the physician is compensated for the services by the center.

SOURCE: IA Department of Human Services, Provider Specific Policies Ch. III: Federally Qualified Health Centers, June 1, 2014, Pg. 32 & 44 (Accessed Jul. 2022). 

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Kansas

Last updated 08/24/2022

If the RHC or FQHC services are in a setting …

If the RHC or FQHC services are in a setting outside of the clinic, the appropriate POS code must be used. For example, if an RHC or FQHC service is provided in a skilled nursing facility (SNF), POS code 31 is applicable. If an RHC or FQHC service is provided in the home, POS code 12 is applicable. Code 13 is the billable POS code for assisted living facilities.

If the service is furnished at a location other than the facility (such as the patient’s place of residence, the scene of an accident), the coverage as an RHC/FQHC encounter depends on whether there is an agreement that the clinic/center would compensate the practitioner for furnishing services in a location away from the clinic/center. The following criteria apply for billing for these services:

  • Practitioner Compensated: The service is covered as an RHC/FQHC visit and should only be billed under the RHC/FQHC provider number. It may not be billed under any other Medicaid provider number.
  • Practitioner Not Compensated: The service is not covered as an RHC/FQHC visit. It can be billed under the performing provider’s individual Medicaid provider number.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-4 to 5 (Aug. 2022), (Accessed Aug. 2022).

Federally qualified health center services provided at a location other than a federally qualified health center shall meet the following conditions:

  • No services are provided at an inpatient hospital, outpatient hospital, or hospital emergency room.
  • The services provided are listed in subsection (b).
  • The services are provided to a patient of a federally qualified health center.
  • The health professional providing the services is an employee of a federally qualified health center or under contract with a federally qualified health center and is required to seek compensation for that person’s services from the federally qualified health center.

SOURCE: KS Admin. Regulation Sec. 129-5-118, (Accessed Aug. 2022).

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Kentucky

Last updated 10/31/2022

Health insurers shall:

  • Reimburse a rural health clinic, federally qualified

Health insurers shall:

  • Reimburse a rural health clinic, federally qualified health clinic, or federally qualified health center look-alike for covered telehealth services provided by a provider employed by the rural health clinic, federally qualified health clinic, or federally qualified health center lookalike, regardless of whether the provider was physically located on the premises of the rural health clinic, federally qualified health clinic, or federally qualified health clinic look-alike when the telehealth service was provided.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Oct. 2022).

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Louisiana

Last updated 11/08/2022

Medicaid allows FQHCs to bill with POS code 10 indicating …

Medicaid allows FQHCs to bill with POS code 10 indicating the patient is at their home.

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

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Maine

Last updated 10/18/2022

Off-site delivery of services furnished by health center staff are …

Off-site delivery of services furnished by health center staff are reimbursable when they are provided away from the center and when it is documented in the member’s chart that it is the most clinically appropriate setting for the provision of services. Examples of off-site service locations include: a nursing facility, an emergency room, an inpatient hospital, or a member’s home.

Visiting nurse services will be reimbursed when:

  • a registered nurse or licensed practical nurse provides the services to a member who is homebound;
  • the services are provided in accordance with a written plan of treatment;
  • the member’s record documents that the member would not otherwise receive these services;
  • the services are provided in an area for which the Secretary of the US Department of Health and Human Services has determined there is a shortage of home health agencies; and
  • the health center that provides in-home services by a registered or licensed practical nurse is licensed by the State of Maine as a home health service provider.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 31.04-4, 10-144 Ch. 101, Sec. 31, pg. 5. (Accessed Oct. 2022).

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Maryland

Last updated 11/22/2022

No explicit telehealth reference found.

The Program shall provide health …

No explicit telehealth reference found.

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 11/17/2022

A home visit must be used to deliver episodic care

A home visit must be used to deliver episodic care in the member’s home when a health practitioner has determined that it is not advisable for the member to visit the CHC. The medical record must document the reasons for a home visit. A house-bound member with chronic medical and nursing care needs must be referred to a Medicare-certified home health agency.

SOURCE: MA 130 CMR 405.421, (Accessed Nov. 2022).

A CHC must provide on site the medical services specified in 130 CMR 405.408. It is not necessary that all of these services be available during all hours of the CHC’s operation, but all must be available to members on a regularly scheduled basis with sufficient frequency to ensure access to care and continuity of care. If the CHC does not serve patients of a particular age group, upon the prior written approval of the MassHealth agency, the CHC will not be required to provide pediatric or obstetrical/gynecological services or both (see 130 CMR 405.408(A) and (C)).

All of the services listed in 130 CMR 405.409 must be provided on site or, alternatively, through a referral network. For the purpose of 130 CMR 405.409, a service furnished by a practitioner other than an employee or contractor of the CHC for which the practitioner, rather than the CHC, claims payment is not considered to be “on site,” even if the service is provided on CHC premises. With the exception of audiology, electrocardiogram, laboratory, and radiology services, the CHC must notify the MassHealth agency, in writing, of each service listed in 130 CMR 405.409(A) through (N) that the CHC will provide on site. All services provided on site must be furnished by practitioners qualified to provide the service that are employees or contractors of the CHC. With the exceptions of audiology, electrocardiogram, laboratory, and radiology services provided on site (for which such services must be furnished and payment claimed by the CHC in accordance with applicable provisions set forth in 130 CMR 405.000 and Subchapter 6 of the Community Health Center Manual), all services set forth below that are provided on site must be furnished, and associated payment claimed by the CHC, in compliance with the applicable MassHealth regulations and subchapter 6 for each such service, including applicable fee schedules. See regulations for referral requirements.

SOURCE: MA 130 CMR 405.408 & 405.409, (Accessed Nov. 2022).

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Michigan

Last updated 11/22/2022

Off-site services provided by employed practitioners of the FQHC to …

Off-site services provided by employed practitioners of the FQHC to beneficiaries temporarily homebound or in any assisted living or skilled nursing facility because of a medical condition that prevents the beneficiary from traveling to the FQHC are also allowable for reimbursement under the PPS or the MOU.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 736-737, Oct. 1, 2022 (Accessed Nov. 2022). 

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Minnesota

Last updated 10/24/2022

RN or LPN part-time or intermittent nursing care

  • In an

RN or LPN part-time or intermittent nursing care

  • In an area in which a shortage of home health agencies exists, part-time or intermittent nursing care by a registered nurse or licensed practical nurse to a homebound person under a written plan of treatment, either established and reviewed by a physician every 60 days or established by a nurse practitioner or physician assistant and reviewed at least every 60 days by a supervising physician.

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

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Mississippi

Last updated 11/17/2022

No reference found

No reference found

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Missouri

Last updated 08/19/2022

No reference found

No reference found

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Montana

Last updated 11/01/2022

Clinic services are covered when provided in outpatient settings including …

Clinic services are covered when provided in outpatient settings including the clinic, other medical facility (including a dental office), or a member’s place of residence. A member’s place of residence may be a nursing facility or other institution used as the member’s home.

Allowable services are reimbursed when provided in outpatient settings including the clinic, other medical facility (including a dental office) or a member’s place of residence. A member’s place of residence may be a nursing facility or other institution used as the member’s home. Clinic services are covered off-site if the service is normally furnished within the scope of the clinic’s professional services. RHC and FQHC providers who perform services in a hospital setting must bill the service on a CMS-1500 form. The RHC or FQHC must be submitted as the billing provider and the individual provider that provided services must be submitted as the rendering provider on the CMS-1500 claim form.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, FQHC and RHC Provider Manual (Nov. 2021). (Accessed Oct. 2022).

RHC or FQHC services are covered by Montana Medicaid when provided in accordance with these rules to a member in an outpatient setting, including the RHC ro FQHC, other medical facility (including a dental office), or a member’s place of residence. A member’s place of residence may be a nursing facility or other institution.

SOURCE: Administrative Rules of Montana 37.86.4406, (Accessed Oct. 2022).

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Nebraska

Last updated 11/18/2022

No reference found

No reference found

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Nevada

Last updated 11/03/2022

Services may include home visits

SOURCE: Federally Qualified Health Center

New Hampshire

Last updated 11/10/2022

No reference found

No reference found

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New Jersey

Last updated 09/06/2022

No reference found

No reference found

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New Mexico

Last updated 10/28/2022

FQHC services furnished off-site (including those furnished to a person …

FQHC services furnished off-site (including those furnished to a person who is an inpatient of a hospital or nursing facility) will be considered FQHC services only if the physician’s agreement with the FQHC requires that he or she seek compensation from the FQHC.

SOURCE: NM Administrative Code 8.310.4.12. (Accessed Oct. 2022).

Home Health Reimbursement

Visiting nurse services

Visiting nurse services are covered if the FQHC is located in an area identified by the secretary of health and human services as having a shortage of home health agencies. No additional certification is required beyond the FQHC certification. To be covered, visiting nurse services must be:

  • rendered to clients who meet criteria for home health services;
  • furnished by a registered nurse, licensed practical nurse, or licensed vocational nurse who is employed by or under contract with the FQHC; and
  • furnished under a written plan of treatment that is established and signed by a supervising physician; the plan may also be established by a nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner employed by or under contract with the FQHC; the plan must be reviewed every 60 days by the supervising physician and revised as the client’s condition warrants;
  • visiting nurse services do not include household and housekeeping services or other services that constitute custodial care.

It is unclear whether telehealth can be used to deliver these services.

SOURCE: NM Administrative Code 8.310.4.12. (Accessed Oct. 2022).

FQHC services are covered when provided in outpatient settings only, including a client’s place of residence, which may be a skilled nursing facility or a nursing facility or other institution used as a client’s home. FQHC services are not covered in a hospital as defined in section 1861(e)(1) of the Act.

SOURCE: NM Administrative Code 8.310.4.14. (Accessed Oct. 2022).

It is unclear whether FQHCs can deliver these services via telehealth. Telehealth is only mentioned the document in reference to referral to community and social support services.

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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.

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

FQHC and RHC core service providers may conduct telehealth visits …

FQHC and RHC core service providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients and bill using HCPCS code T1015 (or T1015-HI, T1015-SC), for a range of scenarios including (but not limited to) chronic disease management and perinatal visits.

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 Nov. 2022).

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: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, pg. 19 Dec. 1, 2020. (Accessed Nov. 2022).

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North Dakota

Last updated 11/08/2022

While the  Telemedicine Section of the General Information Medicaid Manual …

While the  Telemedicine Section of the General Information Medicaid Manual indicates that Indian Health Service facilities or Tribal 638 clinics can be reimbursed regardless of whether the originating site is outside the four walls of the facility or clinic, no reference is found for FHQCs.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Nov. 2022). 

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Ohio

Last updated 09/07/2022

A visit may take place at an FQHC or RHC …

A visit may take place at an FQHC or RHC site, in a patient’s home, at a related off-site location, or (for transportation) between an FQHC or RHC site and a patient’s home or a related off-site location.

SOURCE: OH Administrative Code 5160-28-01. (Accessed Sept. 2022).

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Oklahoma

Last updated 09/05/2022

Health Center services are covered for SoonerCare adults and children …

Health Center services are covered for SoonerCare adults and children as set forth in this Part, unless otherwise specified.

Visiting nurse services to the homebound are covered if:

  • The FQHC is located in an area in which the Secretary of Health and Human Services has determined there is a shortage of home health agencies;
  • The services are rendered to members who are homebound;
  • The member is furnished nursing care on a part-time or intermittent basis by a registered nurse, licensed practical nurse, or licensed vocational nurse who is employed by or receives compensation for the services from the FQHC; and
  • The services are furnished under a written plan of treatment as required by 42 C.F.R § 405.2416.

SOURCE: OK Admin. Rule 317:30-5-661.1. (Accessed Sept. 2022).

Services provided to members within the four walls of the Health Center and approved Health Center satellites including mobile health clinics operated by the Center are allowable for reimbursement under the PPS.

Off-site services provided by employed practitioners of the Health Center to patients temporarily homebound or in any skilled nursing facility because of a medical condition that prevents the patient from going to the Health Center for health care are also allowable for reimbursement under the PPS encounter rate if the service would be reimbursed the PPS at the Center. It is expected that services provided in off-site settings should be, in most cases, temporary and intermittent, i.e., when the member cannot come to the clinic due to health reasons.

SOURCE: OK Admin. Rule 317:30-5-661.7. (Accessed Sept. 2022).

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Oregon

Last updated 11/10/2022

No reference found

No reference found

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Pennsylvania

Last updated 09/06/2022

An encounter may take place in the FQHC/RHC or at

An encounter may take place in the FQHC/RHC or at any other location in which project-supported activities are carried out. Examples of other locations include mobile vans, shelters, hospitals, patients’ homes, and schools.

SOURCE: PA PROMISe Provider Handbook pg. 11, Appendix E, FQHC/RHC   (Accessed Sept. 2022).

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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

Home is allowed as originating site in RI Medicaid, however …

Home is allowed as originating site in RI Medicaid, however it is unclear if it applies to FQHCs.

See: RI Medicaid Live Video Eligible Sites

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South Carolina

Last updated 08/12/2022

FQHC services are covered when furnished to patients at the …

FQHC services are covered when furnished to patients at the center, in a SNF, or at the client’s place of residence. Services provided to hospital patients, including ER services, are not considered FQHC services.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 143 (July 2022). (Accessed Aug. 2022).

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South Dakota

Last updated 11/10/2022

FQHC/RHC Services Locations

FQHC/RHC services must be provided at one …

FQHC/RHC Services Locations

FQHC/RHC services must be provided at one of the following locations:

The FQHC or RHC;

  • The recipient’s residence (including an assisted living facility);
  • A skilled nursing facility; or
  • The scene of an accident.

A visit may not take place in the following locations:

  • An inpatient or outpatient department of a hospital, including a critical access hospital; or
  • A facility which has specific requirements that preclude FQHC or RHC visits.

SOURCE: SD Medicaid Billing and Policy Manual, FQHC and RHC Services, June. 2022, pg. 7 (Accessed Nov. 2022).

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Tennessee

Last updated 09/04/2022

“Qualified site” means the office of a healthcare services provider, …

“Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, a facility licensed under title 33, or another location deemed acceptable by the health insurance entity; and Includes, for the provision of behavioral health services provided via telehealth, the patient’s home or a remote location chosen by the patient.

SOURCE: TN Code Annotated, Sec. 56-7-1002, as amended by House Bill 620 & Senate Bill 429, (2021 Session), (Accessed Sept. 2022).

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Texas

Last updated 09/07/2022

A patient site is the place where the client is …

A patient site is the place where the client is physically located. A client’s home may be the patient site for telemedicine medical services.  However, there is no explicit referenced to whether or not FQHCs can provide services to patients while they are outside the FHQC or at home.

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

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Utah

Last updated 08/23/2022

FQHCs must provide preventive health services onsite or by arrangement …

FQHCs must provide preventive health services onsite or by arrangement with another provider and include:

  • well-child services,
  • pediatric eye, ear, and dental screening,
  • mental health and substance use referrals,
  • services that enable individuals to use the services of the health center (including outreach and transportation services,
  • prenatal and perinatal services,
  • voluntary family planning services, and
  • immunizations against vaccine-preventable diseases.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 4, (Accessed Aug. 2022).

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Vermont

Last updated 10/27/2022

No Reference Found.

No Reference Found.

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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

No reference found.

No reference found.

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Washington

Last updated 08/26/2022

Encounter locations – An encounter may take place in the …

Encounter locations – An encounter may take place in the health center or at other locations (such as mobile vans, clients’ homes, and extended care facilities) in which project-supported activities are carried out.

Services outside the FQHC – A service that is considered an encounter when performed in the FQHC is considered an encounter when performed outside the FQHC (e.g., in a nursing facility or in the client’s home) and is payable to the FQHC. A service not considered an encounter when performed inside the FQHC is also not considered an encounter when performed outside the FQHC, regardless of the place of service.

SOURCE: WA HCA Provider Guide, Federally Qualified Health Centers, p. 23 (Aug. 2022), (Accessed Aug. 2022).

FQHC core services include those professional services provided in the office, other medical facility, the patient’s place of residence (including nursing homes), or elsewhere, but not the institutional costs of the hospital, nursing facility, etc. Core services are covered for Medicaid patients.

SOURCE: WA HCA Provider Guide, Federally Qualified Health Centers, p. 44 (Aug. 2022), (Accessed Aug. 2022).

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West Virginia

Last updated 09/02/2022

An FQHC or RHC encounter can also be a visit …

An FQHC or RHC encounter can also be a visit between a homebound patient and a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN) under certain conditions.

Homebound is an individual who is permanently or temporarily confined to his or her place of residence because of a medical or health condition. This individual may be considered homebound if he or she leaves their place of residence infrequently. “Place of Residence” does not include a hospital or long-term care facility. The member is provided with nursing care on a part-time or intermittent basis by an RN, LPN, or LVN that is employed by or receives compensation for the services from the facility. 42 CFR §405.2416

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 6, 8. (July 1, 2019). (Accessed Sept. 2022).

Generally, an authorized originating site may include the home.

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 Sept. 2022).

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Wisconsin

Last updated 11/21/2022

A service that is considered an encounter when performed in …

A service that is considered an encounter when performed in a CHC location is also considered an encounter when performed by a CHC provider in one of the following locations:

  • Mobile units
  • School visits
  • Hospitals
  • Members’ homes
  • Extended care facilities
  • Primary sites of identified contracted clinicians

SOURCE: WI ForwardHealth Online Handbook Community Health Center Encounters, (Accessed Nov. 2022).

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Wyoming

Last updated 10/20/2022

When a practitioner is performing services outside the FQHC facility, …

When a practitioner is performing services outside the FQHC facility, services cannot be billed under the FQHC NPI number. The services will need to be billed under the practitioner’s NPI on a professional/837P claim.

SOURCE: WY Dept. of Health, Medicaid Institutional Provider Manual, pg. 239, (Sept. 30, 2022). (Accessed Oct 2022).

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Federally Qualified Health Center (FQHC)

Home Eligible

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