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

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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.  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.

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Last revised January 4, 2021 - Betsy Nicoletti
Tags: CCM, compliance issues, preventive medicine services, TCM, Wellness Visits

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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.

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