FQHC Billing Services
Federally Qualified Health Centers are paid differently from private practices. Medicare pays a single rate for a qualifying visit, not for each separate service. Medicaid payment is also set by state rules, and many centers serve patients on sliding fee scales or with no coverage.
FQHC billing depends on knowing what counts as a visit and what gets bundled into it. Westmont Revenue Partners connects health centers with vetted medical billing experts who understand these rules. They can help you report visits correctly, track grant and program requirements, and keep claims moving across Medicare, Medicaid, managed care, and commercial payers.
Who this is for
- Federally Qualified Health Centers and look-alike health centers
- Community health centers with medical, dental, and behavioral health programs
- Migrant, homeless, and school-based health programs run by a center
- Center business office leaders and finance staff
- Centers that plan to add telehealth or care management services
What gets billed
- Medical visits for new and established patients
- Initial preventive exams and annual wellness visits
- Mental health visits with an FQHC practitioner
- Chronic care management and behavioral health integration
- Psychiatric collaborative care model services
- Dental services under the center's dental program
- Prenatal and well-child visits
- Immunizations and screening services
- Telehealth visits, where payers allow them
- Medicaid encounters under the state's payment method
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| G0466 | HCPCS | FQHC visit for a new patient |
| G0467 | HCPCS | FQHC visit for an established patient |
| G0468 | HCPCS | FQHC visit that includes an initial preventive exam or annual wellness visit |
| G0469 | HCPCS | FQHC mental health visit, new patient |
| G0470 | HCPCS | FQHC mental health visit, established patient |
| G0402 | HCPCS | Initial preventive physical exam |
| 95 | Modifier | Mental health visit by real-time audio and video |
| 93 | Modifier | Mental health visit by audio only |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in FQHC
Defining a billable visit. Under Medicare, a qualifying visit is a face-to-face encounter with an eligible practitioner. Services bundled into that visit are not billed separately. Experienced billers train staff on what counts so valid visits are not missed.
Medicare PPS versus Medicaid methods. States set their own Medicaid payment method for health centers, which may be a per-visit rate or another approach. Billers keep Medicare and Medicaid rules separate and watch for payer updates.
Same-day visits. Medical and mental health visits on the same day may be handled differently. Billers check payer rules before submitting more than one visit for a patient on a single date.
Telehealth changes. Medicare telehealth rules for health centers have changed more than once. Mental health visits by telehealth are billed with the visit codes, using modifiers for audio-video or audio-only. Billers should check current-year Medicare updates before each change.
Care management documentation. Monthly care management services depend on documented clinical staff time and patient consent. Billers build simple tracking so time and consent are on file. Medicare retired some center-specific care management codes in 2026, so billers confirm the current code set.
Managed care and wraparound payments. Some states pay health centers an additional amount when a managed care plan pays less than the center's rate. Billers track those reconciliations carefully.
Sliding fee and uninsured patients. Centers must apply their sliding fee policy consistently. Billers help set up statements and eligibility checks that match policy.
How Westmont can help
- Match your center with vetted billing experts who work with FQHC visit-based payment
- Support end-to-end revenue cycle work across medical, behavioral, and dental programs
- Help with denial management and payer follow-up
- Connect you with experts who can help with credentialing and enrollment
- Provide a way to compare billing partners before you choose
Frequently asked questions
How does Medicare pay FQHCs?
Medicare pays FQHCs a per-visit rate under a prospective payment system. The center reports a visit code instead of billing each service separately. Rates and adjustments change over time, so check current Medicare updates. Other payers, including Medicaid, use their own methods.
What is the difference between G0466 and G0467?
G0466 is the FQHC visit code for a new patient. G0467 is the code for an established patient. Mental health visits use G0469 and G0470 in the same way. Your biller needs to check how each payer defines a new patient before the claim goes out.
Can FQHCs bill Medicare for telehealth?
Medicare has allowed FQHC telehealth under rules that have been extended several times. Mental health visits are billed with the mental health visit codes plus a telehealth modifier. Rules and end dates can change, so check the latest Medicare guidance before you set up a program.
Are dental services billed the same way?
Not always. Dental services often follow a separate Medicaid or commercial dental process, using dental codes rather than the Medicare visit codes. Your billing expert should review how your state and payers treat dental encounters at health centers.
Should an FQHC outsource billing?
Some centers do, especially when the business office is small. Westmont does not submit claims itself. We connect you with vetted billing experts who know FQHC rules. Ask about reporting, scope, and how they will handle sliding fee and grant reporting needs.
Related billing services
See what simpler billing looks like
Tell us about your practice and we will connect you with vetted billing experts. Contact Westmont for a quote.
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