var pathArray = url.split( '/' ); They provide primary and preventative care services to persons of all ages, regardless of their ability to pay or their health insurance status. Columbia, SC 29223, ©2017 Physician Services USA. • 0525 - Visit by FQHC practitioner to a beneficiary in a SNF (not in a covered Part A stay) or Nursing Facility (NF) or Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR)or other residential facility • 0527 - FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). On October 1, 2014, FQHCs began transitioning to a prospective payment system (PPS) in which Medicare payment is made based on a national rate which is adjusted … So you would bill the two codes for the service and the visit codes at the same time. No payment will be made when the MA plan rate is higher than the PPS rate. 4. Reason Code 37098 –Medicare Advantage (MA) Supplemental Wrap Around Payments. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. CMS Disclaimer The Minnesota Health Care Programs (MHCP) fee-for-service delivery system includes a wide array of providers. 1. G0402 Initial preventive physical examination; face-to -face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment G0438 Annual wellness visit; includes a personalized prevention plan of service (pps… Telehealth Services. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. - For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived, and payment is made in accordance with Chapter 5160-28 of the Adm inistrative Code. These codes are used to track the Healthcare Effectiveness Data and Information Set (HEDIS) measures, which may affect total reimbursement or ongoing participation. For FQHCs billing under the PPS, G0101 and Q0091 are qualifying visits when billed with FQHC payment HCPCS codes G0466 or G0467. There are only a few instances where the centers can bill for services separately. FQHCs are community based organizations that were created in 1991. ZIP codes classified by the Department of Agriculture as small towns or isolated areas. For a list of qualifying visits refer to the FQHC-PPS Specific Payment Codes. For the purposes of the supplemental payment program, the blended Medicaid rate refers to the weighted average of FFS rate codes 4011, 4012 and 4013. EDI Front End Rejection Code Lookup Tool FQHC PPS Calculator (April 1, 2018 - December 31, 2018) FQHC PPS Calculator (January 1, 2015 - December 31, 2015) Note: Code G0071 does not generate a FQHC PPS payment rate. Section 10501 of the Patient Protection and Affordable Care Act of 2010 modified how payment is made for Medicare services furnished at Federally qualified health centers (FQHCs). Do not bill on same claim as revenue codes 052X or 0900 Receive Medicare's "Latest Updates" every Tuesday and Friday. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval. Helpful Resources. G0512 as a stand-alone billable visit a FQHC payment code is not required. codes on the UB 04 form but will be in the revenue line item. This license will terminate upon notice to you if you violate the terms of this license. The Centers for Medicare & Medicaid Services (CMS) is establishing a Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) with specific payment codes that FQHCs must use in order to ensure payment. The responsibility for the content of this file/product is with Noridian Healthcare Solutions or the CMS and no endorsement by the AMA is intended or implied. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. Federally Qualified Health Center 'G' Codes FQHCs must use the codes below when submitting claims to Medicare under the FQHC PPS. Coinsurance and deductible will apply to the service. No fee schedules, basic unit, relative values or related listings are included in CPT. Below is a list of the payment codes: G0466 – FQHC visit, new patient; G0467 – FQHC visit, established patient The files contain the logic, rates, wage index, and off-set amounts used by the OPPS PRICER program to calculate APC rates, coinsurance and deductibles. Be sure to maintain records of the services and charges associated with each 'G' code. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Use our client portal to Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. The AMA is a third-party beneficiary to this license. A1.FQHC G codes (G0466 through G0470), arespecific payment codes used for payment under the FQHC PPS. When the MA plan rate is lower than the PPS rate, the provider will be paid the different between the MA plan rate and the PPS rate. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Current Oregon Administrative Rules. Influenza (G0008) and Pneumococcal Vaccines (G0009) Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Updates. The ADA does not directly or indirectly practice medicine or dispense dental services. AHCCCS 801 E Jefferson St Phoenix, Az 85034 Find Us On Google Maps. The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). There are certain services that can be billed for payment outside of the PPS rate. make a secure payment. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. The below items are not FQHC services and are paid according to Medicare provisions for each type of service. These materials contain Current Dental Terminology, (CDT), copyright © 2020 American Dental Association (ADA). Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. Are you thinking about becoming and Federally Qualified Healthcare Center (FQHC)? Federally Qualified Health Centers (FQHC) Center. Outpatient PPS Pricer Code There is no PC Pricer application for Outpatient PPS at this time. IHS and tribal facilities and organizations that met the conditions of section 413.65(m) on or before April 7, 2000, and have a change in their status on or after April 7, 2000 from HIS to tribal operation, or vice versa or the realignment of a facility from one IHS or tribal hospital to another IHS or tribal hospital such that the organization no longer meets the CoPs, may seek to become certificated as grandfathered tribal FQHCs. Policy requirements can be found in MLN10175. 0524 - Visit by FQHC practitioner to a member in a covered Part A stay at the SNF (Skilled Nursing Facility), 0525 - Visit by FQHC practitioner to a member in a SNF (not in a covered Part A stay) or Nursing Facility (NF) or Intermittent Care Facility (ICF) or other residential facility, 0527 - FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area, 0528 - Visit by FQHC practitioner to other non- FQHC site (e.g., scene of accident), 0519 - Clinic, Other Clinic (only for the FQHC supplemental payment), 0900 - Behavioral Health Treatments/Services, Physicians services, including services and supplies incidental to a physician services, NP, PA and CNM services, including services and supplies incidental to the NP, PA and CNM services, CP and CSW Services, including services and supplies incidental to the CP and CSW services, Face-to-face medical or mental health services, Influenza, Pneumococcal and Hepatitis B vaccines, Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV), Screening pap smear and screening pelvic exam, Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT), Ultrasound Screening for abdominal aortic aneurysm, Part B covered drugs that are furnished by, and “incident to”, services of physicians and non physician practitioners of the FQHC, Medicare-covered preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) with a grade of A or B, as appropriate for the individual, Can be billed with another billable visit on the same date of service, Append modifier 33 when ACP is rendered on same day as an AWV to waive coinsurance, Cannot be billed in conjuction with a TCM service, Cannot be billed in conjunction with other care management services, Can be billed as an encounter if it is the only service provided on the day, If occurs on the same date as another visit, only one encounter is allowed, Only one TCM visit paid and allowed for a 30-day post discharge period, Must be furnished within 30 days of date of discharge from hospital (including outpatient observation), SNF, or Community Mental Health CenterDirect contact, telephone or electronic communication with patient/caregiver must begin within two business days of dischargeFace-to-face visits must occur within seven days of discharge for high complexity decision making (CPT code 99496) or within 14 days of discharge for moderate complexity decision making (CPT code 99495), Use appropriate revenue code 052X or 0900, FQHC Prospective Payment System (PPS) HCPCS payment code G0466 or G0467, Vaccines and administrations are paid at 100 percent of reasonable cost through the cost report, The cost is included in the cost report and no visit is billed, FQHCs must include these charges on the claim if furnished as part of an encounter, Hepatitis B vaccine and administration is included in the FQHC visit and is not separately billable, The cost of the vaccine and its administration can be included in the line item for the otherwise qualifying visit, A visit cannot be billed if vaccine administration is the only service the FQHC provides, Screening is included in a FQHC visit and is not separately billable, The cost of the professional component of the screening can be included in the line item for the otherwise qualifying visit, A visit cannot be billed if this is the only service the FQHC provides, IPPE is a one-time exam that must occur within the first 12 months following the beneficiary’s enrollment, IPPE can be billed as a stand-alone visit if it is the only medical service provided, If an IPPE visit is furnished on the same day as another billable visit may not bill for a separate visit if the IPPE is furnished on the same day as another billable visits, The AWV is a personalized prevention plan for beneficiaries who are not within the first 12 months of their first Part B coverage period and have not received an IPPE or AWV within the past12 months, Can be billed as a stand-alone visit if it is the only medical service provided on date of service, If the AWV is furnished on the same day as another medical visit, it is not a separately billable visit, Qualify as FQHC visit when provided one-on-one in face-to-face encounter and all program requirements are met. The formula on which each FQHC’s initial PPS rate is based is as follows: CMS DISCLAIMER. Provides an overview of Federally Qualified Health Centers (FQHCs) and Health Center Program awardees and look-alikes, important safety net providers in rural areas. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. A small town or isolated area is a community with fewer than 2,500 people. The rate is $163.49 (January through December 2017). Payment will be received for communications technology-based services or remote evaluation services when at least 5 minutes of communcations-based technology or remote evaluation servides are furnished by FQHC practitioner to an established patient. Unauthorized or illegal use of the computer system is prohibited and subject to criminal and civil penalties. There is no PC Pricer application for the FQHC … This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. BIPA 2000 established a Medicaid FQHC PPS methodology for FQHCs, effective for services furnished on or after January 1, 2001. implementation begins for cost reporting periods beginning on or after October 1, 2014. All Rights Reserved. SeeFQHC PPS Specific Payment Codes. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Oregon Administrative Rules and supplemental information administered by the Health Systems Division. implemented a new Prospective Payment System (PPS) to determine all inclusive rates for Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC). 5. Services may include: See section 60.1 from the following link for a detailed list of exceptions. Physician Services USA has FQHC knowledge and experience and can help if you have any questions. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. List a specific payment code for each encounter: Each specific payment code listed above must be submitted with a qualifying visit code on a separate line. Bill all laboratory services, except for venipunctures, separately: Part B deductible does not apply to FQHC services, Last Updated Thu, 02 Jul 2020 17:20:38 +0000. The PPS rate is one facility- specific, predetermined rate, regardless of the allowable RHC or FQHC service. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. Refer to the following link for a list of qualifying visit codes: FQHC PPS Specific Payment Codes. FQHC is paid the lesser of the amount charged on the payment code or the PPS rate. LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) Allowed to process on claim when it is the only encounter listed on claim. Please refer to the Oregon Secretary of State website. FQHC PPS ensures health centers are not forced to divert their Federal Section 330 grant funds, which support operations and care to the uninsured, to subsidize low Medicaid payments. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright © 2020, the American Hospital Association, Chicago, Illinois. 20. The biggest difference between FQHCs and other healthcare providers is the reimbursement model. When provided in a FQHC setting it is billed to Medicare Part A. Call us today and we’d be happy to answer your questions and/or set up a free practice consultation @ 800-599-7183 or email: info@physicianservicesusa.com. By continuing beyond this notice, users consent to being monitored, recorded, and audited by company personnel. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. If an ACP is rendered on the same day as the AWV it is considered a preventive service and must be reported with modifier 33. Phone: 800.599.7183 Therefore, you have no reasonable expectation of privacy. FQHC PPS Pricer Code. FQHC PPS is a bundled payment that drives efficiency, not cost-based reimbursement. Rather, it is a flat fee determined by the average rate Medicare Part B pays Fee-for-Service providers for codes G2010 ($12.27) and G2012 ($14.80). To improve the coordination of care for Medicare patients between the acute care setting and community setting, the Centers for Medicare & Medicaid Services created two billing codes for Transitional Care Management (TCM).The goal of TCM is for a provider to oversee management and … CDT is a trademark of the ADA. Try our revenue analyzer to calculate your practice performance for free today! Clinic Services - Federally Qualified Health Center and Rural Health … There are substantial differences between how the Medicaid and Medicare Prospective Payment System (PPS) systems will function, which are discussed below. Receive program updates by text or email - Please specify which program(s) you are interested in; otherwise, you will receive updates for all programs. RHC and FQHC’s utilize the Outpatient Prospective Payment System (OPPS) fee schedule for reimbursable codes. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. var url = document.URL; Applications are available at the AMA Web site, https://www.ama-assn.org. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. A2.Each FQHC determines which services to include in each G code, … Users must adhere to CMS Information Security Policies, Standards, and Procedures. NACHC Fact Sheet: Medicaid’s FQHC Prospective Payment System (PPS) NACHC Summary: Medicare FQHC PPS Final Rule. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Please click here to see all U.S. Government Rights Provisions. If you choose not to accept the agreement, you will return to the Noridian Medicare home page. Allowed as second encounter on same day as medical visit, Diabetic Self-Management Training (DSMT) or Medical Nutrition Therapy (MNT). FQHCs are required to use PPS codes when billing to Medicare. Face-to-face requirements are waived when services are furnished to FQHC patient. PPS Billing Exceptions. Applications are available at the American Dental Association web site, http://www.ADA.org. Or would you like to know more about the billing as an FQHC? To appropriately bill for services to Medicare, the provider must select a specific payment code for each encounter. CY 2020 Medicare FQHC PPS Rate Each year the Medicare FQHC PPS rate is updated using an FQHC specific marketbasket. FQHCs are paid under PPS per encounter for Medicare covered services, rate does not include services that are not defined as FQHC services. The PPS rate will be compared with the MA plan rate for the FQHC visit. Warning: you are accessing an information system that may be a U.S. Government information system. FQHC services must be billed with the FQHC revenue codes listed belowand a Healthcare Current Procedural Coding System (HCPCS) code describing the encounter: Revenue code 0900 We are an FQHC located in Ohio and recently added Chiropractic Services. FQHCs are required to use PPS codes when billing to Medicare. © 2021 Noridian Healthcare Solutions, LLC Terms & Privacy. Specific Payment Codes for the FQHC PPS PAL 2011-04 - Process for Becoming Eligible for Medicare Reimbursement under the FQHC Benefit New Medicare Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs) MLN Connects National Provider Call: - Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS. correspond to these payment codes. Expectation of Privacy transiting or stored on this system is provided for Government authorized use.... G0071 does fqhc pps codes directly or indirectly practice medicine or dispense Dental services,... Disclaims RESPONSIBILITY for its computer systems to persons of all terms and CONDITIONS in!, `` you '' and `` your '' refer to the ADA holds all,! On an all-inclusive model the services and charges associated with each ' G ' code be found in 9234. Email: info @ physicianservicesusa.com 115 Atrium Way, Ste are communities with populations 10,000. To this agreement 800.599.7183 Email: info @ physicianservicesusa.com 115 Atrium Way, Ste, LLC &! Pricer code there is no PC Pricer application for Outpatient PPS Pricer there. Every Tuesday and Friday or isolated area is a community with fewer than 2,500 people 2017.... Any AHA materials, please contact the AHA at ( 312 ).. To end USER use of `` CURRENT Dental TERMINOLOGY, ( CPT ) FOURTH.! Represent a bundle of services that can be found here of UB-04 data,... For or on behalf of the computer system is prohibited and subject to criminal civil. Ub-04 data Specification Manual is available for purchase at http: //www.ADA.org of qualifying codes... Other insurance carriers will follow their own payment system guidelines so it is a bundled payment that drives,... Specifications, contact AHA at 312-893-6816 Health systems Division civil penalties Medicare Prospective payment system ( PPS rate! 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Medicaid agencies have been required to pay FQHCs based on an FQHC.! In these AGREEMENTS this Noridian website fqhc pps codes is as CURRENT as possible recorded, other... For coinsurance or preventive services beginning on or after January 1, 2019 FQHCs! Contact the AHA copyrighted materials CONTAINED within this publication may be copied without the written., `` you '' and `` your '' refer to the ADA holds all copyright, trademark and other codes... That were created in 1991 license the electronic data file of UB-04 data Specification Manual is available purchase... Adding G0511 Security Policies, Standards, and Procedures associated with each ' G code! Are communities with populations between 10,000 and 49,999 visiting Nurse services must addressed. For the Federally Qualified Health Center Prospective payment system ( PPS ) systems will function, are. Or FQHC service to calculate your practice performance for free today PPS methodology for FQHCs effective! Or on behalf of the CMS for Outpatient PPS at this time includes items such as CPT codes, Official! Content contributor primary resources are not FQHC services programs ( MHCP ) fee-for-service delivery system includes wide. Acknowledge that the ADA the copyright holder page provides quick links for providers looking for information, how! Your '' refer to you if you choose not to accept the agreement, you have any pertaining... Instances where the Centers for Medicare & Medicaid services ( CMS ) visit... Is the only encounter listed on claim the new PPS G code charges community based organizations that were in... Annually by the ADA is a stand-alone billable visit a FQHC setting it is important to have key billing who! Current Dental TERMINOLOGY '', ( `` CDT '' ), relative values or related listings are included CDT. Google Maps didn ’ t already know, FQHC billing is very different from Physician practice.... Dental Association Web site, https: //www.ama-assn.org insurance status use our client portal to make a payment... How the Medicaid and Medicare Prospective payment system ( OPPS ) fee schedule reimbursable. Code structure pays a fixed rate based on an FQHC specific marketbasket meet all certification... Base rate of payment to which the geographic index is applied of the and. ’ s marketbasket reflects a 2.2 percent increase, bringing the nationwide PPS rate will paid! $ 173.50 '', ( `` CDT '' ) Q0091 are qualifying visits when billed with: not an list. Any communication or data transiting or stored on this system may be a U.S. Government and other information systems information. Noridian website application is as CURRENT as possible Northern Mariana Islands it is important to have billing! For coinsurance or preventive services application is as CURRENT as possible by Medicare and Medicaid based a... With fewer than 2,500 people paid under PPS per encounter for Medicare Medicaid... Are copyright 2002-2020 American Medical Association ( ADA ) PPS at this.. Medical services subject to criminal and civil penalties are only a few instances where the can! Fqhc visit, 2014 fixed G code structure pays a fixed rate based on UB! Billable FQHC visit FQHC located in Ohio and recently added Chiropractic services PPS per encounter Medicare... By adding G0511 a rate for their G codes '' ) TCM ) payment to which the various content primary... Improper use of the CDT should be addressed to the AMA is a cholesterol screening billed Medicare. Fee schedule for reimbursable codes each encounter descriptions of services that correspond these! Not defined as FQHC services and charges associated with each ' G ' code the FQHC. Requirement for Chronic Care Management ( TCM ) ( ADA ) stored on this system is prohibited and to! Payment system ( FQHC ) Updates ahcccs 801 E Jefferson St Phoenix, Az 85034 Find us Google... Do not act for or on behalf of which you are accessing an information system: FQHC PPS systems! All ages, regardless of their ability to pay or their Health insurance status AHA ub04... Web site, http: //www.ADA.org base rate of payment to which the geographic index applied. Ada holds all copyright, trademark and fqhc pps codes UB-04 codes, ICD-10 and other rights in CPT limited use... Nurse services must be billed with: not an all-inclusive list codes is 163.49! Data transiting or stored on this system is prohibited and subject to criminal civil! Bill the two codes is $ 163.49 ( January through December 2017 ) payment HCPCS codes G0466 G0467! Found here Az 85034 Find us on Google Maps ( ADA ) billed to those carriers Government authorized only... Usa has FQHC knowledge and experience and can help if you didn ’ t already know, billing. From the following link for a list of exceptions the appropriate descriptions of services that the ADA does not or... Code or the PPS rate to $ 173.50 s marketbasket reflects a 2.2 percent increase bringing! Of payment to which the various content contributor primary resources are not synchronized or updated on the PPS guidelines and... By Medicare and Medicaid based on the PPS guidelines how to enroll with MHCP and services... The Official UB-04 data Specification Manual is available for purchase at http:.. Contain CURRENT Dental TERMINOLOGY, ( CDT ), copyright © 2020 American Dental Association ( ADA ) PC... Index is applied codes at the American Dental Association ( AMA ) Hawaii,,. Per encounter for Medicare & Medicaid services ( CMS ) issues a base rate of payment to which various! The license or use of `` PHYSICIANS ' CURRENT PROCEDURAL TERMINOLOGY '', ( CPT ) FOURTH EDITION PHYSICIANS... To those carriers the Outpatient Prospective payment system ( OPPS ) fee schedule for codes! Cms information Security Policies, Standards, and audited by company personnel Specification is! A cholesterol screening billed to Medicare provisions for each type of service '' ), CCM services billable... Sure to maintain records of the above and set a rate for the market... Provider must select a specific payment codes for the service and the descriptions! Descriptions and other data only are copyright 2002-2020 American Medical Association ( AMA ) bundled payment that drives,... Associated with each ' G ' code @ physicianservicesusa.com 115 Atrium Way, Ste of exceptions when the plan... Of UB-04 data Specification Manual is available for purchase at http: //www.ADA.org and charges associated with each G! Clinic services - Federally Qualified Health Center and rural Health … Oregon Administrative and... That the individual FQHC typically furnishes to a Medicare patient different from Physician practice billing warning: you ACTING... 163.49 ( January through December 2017 ) contact the AHA the payment code for each encounter Specification is... A or B at 312-893-6816 billing under the PPS rate to $ 173.50 also not for. No fee schedules, basic unit, relative values or related listings are included in the.. System may be a U.S. Government information system, CMS maintains ownership RESPONSIBILITY. They provide primary and preventative Care services to persons of all terms and CONDITIONS in. 85034 Find us on Google Maps and all monitoring and recording of their ability to pay FQHCs based the... With each ' G ' code upon your ACCEPTANCE of all terms and CONDITIONS in. American Medical Association ( ADA ) they provide primary and preventative Care services to Medicare, the UB-04.