Federally qualified health center (FQHC) services
Services
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Physician services
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Services and supplies furnished incident to a physician’s services
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Nurse practitioner (NP), physician assistant PA), certified nurse midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services
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Services and supplies furnished incident to an NP, PA, CNM, CP, or CSW services
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Outpatient diabetes self-management training (DSMT) and medical nutrition therapy (MNT) for beneficiaries with diabetes or renal disease
Covered services
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Medically necessary and reasonable
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Physician services
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Services and supplies “incident to” the services of physicians
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Non-physician practitioners (NP, PA, CNM, CP and CSW)
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Services and supplies “incident to” non-physician practitioners
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Visiting nurse services to the homebound in an area where CMS has determined that there is a shortage of home health agencies
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Otherwise covered drugs that are furnished by, and “incident to,” services of physicians and non-physician practitioners of the federally qualified health center (FQHC)
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Outpatient DSMT and MNT for beneficiaries with diabetes or renal disease
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Preventive primary health services when furnished by or under the direct supervision of a physician or non-physician practitioner
Certain services are not considered FQHC services either because they are not included in the FQHC benefit, or they are not a Medicare benefit.
Non-Federally Qualified Health Center services
Non-FQHC services include, but are not limited to: Medicare excluded services, such as routine physical checkups, dental care, hearing tests, routine eye exams, etc.
For additional information, please review the CMS IOM Publication 100-02, Benefit Policy Manual, Chapter 16.
Technical component
The technical component of a FQHC service includes diagnostic tests such as X-rays, electrocardiograms and other tests authorized by Medicare statute or the National Coverage Determination process.
These services may be billed separately.
Professional component
The professional component is a FQHC service if performed by a FQHC practitioner or furnished incident to a FQHC service.
Laboratory services
Although FQHCs are required to furnish certain laboratory services (section 330(b)(1)(A)(i)(II) of the PHS Act), they are not within the scope of the FQHC benefit.
When clinics and centers separately bill laboratory services, the cost of space, equipment, supplies, facility overhead and personnel must be adjusted out of the FQHC cost report. This does not include venipuncture, which is in the per-diem payment when furnished in a FQHC by a FQHC practitioner or furnished incident to a FQHC service.
Qualifying visits
For a list of qualifying visits, please review the FQHC PPS Specific Payment Codes document located on the CMS FQHC Center.
Reference