Federally qualified health center (FQHC): Non-FQHC services, laboratory services and technical component services
Certain services are not considered FQHC services because either they are:
- Not included in the FQHC benefit or
- Not a Medicare benefit
Non-FQHC services include, but are not limited to:
- Medicare excluded services
- Routine physical checkups
- Dental care
- Hearing tests
- Routine eye exams, etc.
- Durable Medical Equipment (DME)
- Ambulance services
- Prosthetic devices
- Body braces (including replacements)
- Practitioner services at certain other Medicare facilities (services furnished to inpatients or outpatients in a hospital (including CAHs), ambulatory surgical center, comprehensive outpatient rehabilitation facility or other facilities whose requirements preclude FQHC services)
Note: Covered services provided to a Medicare beneficiary by a FQHC practitioner in a SNF may be a FQHC service.
- Telehealth distant-site services
- Hospice services
- Group services (group or mass information programs, health education classes)
Laboratory services
FQHCs lab services are not within the scope of the FQHC; lab services are not included in the encounter rate and must be billed separately to Part B on a 1500 claim form.
Laboratory services not provided during a medical or mental health visit that are billed separately to Part B on the CMS 1500 claim form, cost of the associated space, equipment supplies, facility overhead and personnel for these services must be adjusted out of the FQHC cost report.
This does not include venipuncture, which is included in the FQHC encounter per-diem payment when furnished in an FQHC by an FQHC practitioner or furnished "incident to" a FQHC service.
Technical component services
For services that can be split into professional and technical components, FQHCs bill the technical component to the B/MAC via the CMS 1500 claim form. The professional component is included in the FQHC encounter per-diem payment.
References