• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Free Resources
    • Free Resources Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • E/M Changes
    • How Physician Services Are Paid
    • In Person E/M
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management

Wellness visits and care management in Rural Health Centers and Federally Qualified Health Centers (RHCs and FQHCs)

RHCs and FQHCs are paid an all-inclusive rate (AIR) or national prospective payment system (PPS) rate for any service that is defined as a visit to their facility.  A visit may be with a physician, non-physician practitioner (NPP), psychologist or social worker.

There are some differences in RHC and FQHC rules, but in general, a service identified by a CPT® code is submitted with a revenue code and is paid at the AIR/PPS rate for each type of facility.  All of the services performed are listed on the claim form, but the payment is based on the HCPCS code that identifies the type of visit. Links to the CMS fact sheets for each type of service are listed at the end of this post, as well as FAQ about these services.

Wellness visits in an RHC and FQHC—additional payment in a FQHC

Medicare developed HCPCS codes for three services generally considered wellness visits. These are:

  • G0402 for the welcome to Medicare visit,
  • G0438 for an initial annual wellness visit and
  • G0439 for a subsequent annual wellness visit.

There are resources on CodingIntel that describe patient eligibility and the service requirements for each.

When one of these wellness visits is performed in an RHC, it is paid the same as for any other service defined as a visit.  However, when a wellness visit is provided in an FQHC, it is paid at 134% of the PPS rate.  This provides an incentive to provide the wellness visits in an FQHC.

Login to read the rest of this article

Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

click here!

Last revised December 22, 2021 - Betsy Nicoletti
Tags: compliance issues, FQHC, preventive services for medicare

CMS split/shared services

Questions about CMS split/shared services rule changes? In this quick reference sheet you'll learn what these services are, who can bill them, and where. And, information about "substantive portion" and selecting level of service for time vs. key components..

Get Resource

Recommended Resource

You’ve coded it, but you still have to fight to get paid! We’ve partnered with Elizabeth Woodcock to give you the tools and strategies you need.

Find them here!

Latest Intel

CPT Coding for Obstetrical and Gynecological Procedures | Webinar

Who Runs the World? GIRLS!!: CPT Coding for … Read More...

Payment denials for unspecified codes

From the day coders got their first glimpse at … Read More...

Behavioral health coding compliance

Compliance Lessons from the OIG In March 2022, … Read More...

Acute, uncomplicated vs. acute with systemic symptoms

Question: What is the difference between an … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management category of service CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_E/M services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets E/M rule changes FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding ICD-10 coding level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers other E/M services Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth
  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright 2022, CodingIntel
Privacy Policy