Washington Apple Health (Medicaid) Federally-Qualified Health Centers (FQHC) Billing Guide . CR 11500 informs MACs about updates to the Prospective Payment System (PPS) base payment rate and the Geographic Adjustment Factors (GAFs) for the Federally Qualified Health Center (FQHC) Pricer. See how Medicare can help pay costs for preventive services at approved FQHCs. FQHCs can expect the payment to be slightly higher or lower depending on the GAF/GPCI. • $173.50 and $232.77 are the FQHC unadjusted CMS PPS rate ceilings G2012 ($14.80). HRSA programs provide health care to people who are geographically isolated, economically or medically vulnerable. 1 . Effective Date: January 1, 2020 Implementation Date: January 6, 2020. FQHCs can expect the payment to be slightly higher or lower depending on the GAF/GPCI. • Rates here are based on the 2020 Medicare Physician Fee Schedule (PFS); no Geographical Adjustment Factor (GAF) or Geographic Practice Cost Index (GPCI) has been applied. Select a State or Territory and click the “Submit” button. $226.07 (GAF = .971) Medicare Revenue Statistics Based on the 2017 & 2016 UDS Data (Table 9D ... Medicare FQHC PPS base payment rate 2020 base payment rate of $173.50 includes application of the final FQHC-specific market basket of 2.2% (versus the 2019 MEI increase FQHC GAFs are updated periodically and located on the Centers for Medicare & Medicaid Services (CMS) FQHC Center. Since the FQHC GAF is based on where the services are furnished, the payment rate may differ among FQHC sites within the same organization. Note: Rates here are based on the 2020 Medicare Physician Fee Schedule (PFS); not Geographical Adjustment Factor (GAF) or Geographic Practice Cost Index (GPCI) has been applied. A FQHC may submit a Medicare claim for a billable January 1, 2020 . All Medicare Carrier Locality codes; Carrier Locality State Fee Schedule Area GPCI PW GPCI PE GPCI MP Anesthesia CF FQHC GAF; 10112: 00: AL - Alabama: STATEWIDE: 1.000 FQHCs can expect the payment to be slightly higher or lower depending on the GAF/GPCI. Notes: Rates here are based on the 2020 Medicare Physician Fee Schedule (PFS); no Geographical Adjustment Factor (GAF) or Geographic Practice Cost Index (GPCI) has been applied. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply. About HRSA. Supplemental Payment Submission Forms-Max Entries [366KB MS Excel] Posted March 2, 2020; Prospective Payment System for FQHCs and RHCs [258KB PDF] Posted July 31, 2014; 2020. FQHCs and LALs by State Federally Qualified Health Centers and Look-Alikes. Make sure your billing staffs are aware of these changes. A FQHC may submit a Medicare claim for a billable New Patient Adjustment. Federally Qualified Health Centers . Every effort has been made to ensure this guide’s accuracy. Looking for Federally Qualified Health Center (FQHC) services coverage? Notes: Rates here are based on the 2020 Medicare Physician Fee Schedule (PFS); no Geographical Adjustment Factor (GAF) or Geographic Practice Cost Index (GPCI) has been applied. • 0527 - FQHC Visiting Nurse Service(s) to a member’s home when in a home health shortage area • 0528 - Visit by a FQHC practitioner to other non FQHC site (e.g., scene of accident) • 0900 - Behavioral Health Treatment Revenue Codes FQHCs can expect the payment to be slightly higher or lower depending Medicare PPS Resources General Resources: 330 Health Center authorizing legislation; Medicare GPCI, which is the basis for the Medicare FQHC PPS Geographic Adjustment Factor (GAF) The unadjusted 2020 FFS average payment for these two codes is $13.53. ( Medicaid ) Federally-Qualified Health Centers can expect the payment to be slightly higher lower... 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