evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual Crosswalk)
7 40 SNF-515.6    Billing Part B Rehabilitation Services 7 40.1 AB-02-038 Audiologic Function Tests7 50 SNF-533 A-01-94 Billing Part B Radiology Services and Other Diagnostic Procedures 7 50.1 SNF-535.5 Bone Mass Measurements7 60 SNF-534,SNF-534A    Billing for Durable Medial Equipment (DME), Orthotic/Prosthetic Devices, and Supplies (including Surgical Dressings) 7 60.1 SNF-534B,C,SNF-535 Billing7 60.2 SNF-534D, E    Determining Payment and Patient Liability 7 60.3 SNF-544,SNF-544A    Billing For Enteral and Parenteral Nutritional Therapy as a Prosthetic Device 7 70 SNF-536,SNF-536.1 Drugs7 70.1     Immunosuppressive Drugs Furnished to Transplant Patients 7 80 Screening and Preventive ServicesChap. Sect. SNF Pub 12 Carrier Pub 14. PMs Other Description                                                         7 80.1 SNF-536,2    Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 7 80.2 Mammography Screening7 80.2.1    A3 3660.20 Diagnostic and Screening Mammograms Performed With New Technologies 7 80.3 SNF-541.2  B3-3628.1B Screening Pap Smears7 80.4 B3-3616 Screening Pelvic Examinations7 80.5 B3-3616 Prostate Cancer Screening7 80.6 B3-3660.17 Colorectal Cancer Screening7 80.7 Glaucoma Screening7 90 SNF-541,SNF-541.A,  AB-02-027  Billing for Laboratory Tests Under Part B - General 7 90.1 AB-00-108 Glucose Monitoring7 100 SNF-543 Epoetin (EPO)
(Medicare Claims Processing Manual Crosswalk)
Medicare Claims Processing Manual Chapter 8 - Outpatient ESRD Hospital, Indepe ndent Facility, and Physician/Supplier Claims Crosswalk  New Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provider Reimburse Part 1 PMs                                                                              Other Description8 10 A3-3166   RDF-206 PRM1-2702   General Description of ESRD Payment 8 10.1 A3-3166 RDF-245,RDF-245.2 PRM1-2702   General Description of ESRD Facility Composite Rates  8 10.2 PRM1-2702.1 Uncompleted Treatments8 10.3 PRM1-2702.1 No-Shows8 10.4 RDF-112,RDF-114 Deductible and Coinsurance8 10.5 PRM1-2702.1C   Outpatient Hospital Services Which Become Inpatient Hospital Services 8 10.6 PRM1-2706.1E Amount of Payment8 10.7    RDF-221    ESRD Services Not Provided Within the United States 8 10.8 RDF-207.4 Transportation Services8 20 Definitions Related to CalculatingComposite Rate - section heading only 8 30 Determination and Publication ofComposite Rate - section heading only New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 30.1       PRM1-2706.1,PRM1-2704, PRM1-2706 42 CFR 413.172  Publication of Composite Rates 8 30.2
(Medicare Claims Processing Manual Crosswalk)
PRM1-2706.1 Determining Individual Facility Composite Rate 8 30.3 PRM1-2705 Transition Period8 30.4 PRM1-2717 Record Keeping and ReportingRequirements Under Composite Rate System 8 30.5 PRM1-2728 Facility  Preparation and Intermediary Review of Cost Reports 8 30.6 PRM1-2719 Issuance of Notice of ProgramReimbursement 8 40 PRM1-2720 Processing Requests for Composite RateException 8 50  A3-3644  RDF-207.1 CWF doc  In-Facility Dialysis Bill Processing Procedures 8 50.1    RDF-207.1  A-03-33  Laboratory Services Included In the Composite Rate 8 50.2 A3-3168A       Drugs and Biologicals Included In the Composite Rate 8 50.3 RDF-320 Required Information for In-facilityClaims Paid Under the Composite Rate New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 50.3.1
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 50.3.1                                                                                              RDF-320.1 Submitting Corrected Bills8 50.4  A3-3644.2  Non-Required Items on the FormCMS-1450 for ESRD Bills 8 50.5  A3-3112.6  IPD in the Facility8 50.6 RDF-245.2D In-Facility Back-Up Dialysis8 50.6.1 A3-3644.1,A3-3171.1 Payment for In-Facility MaintenanceDialysis Sessions Furnished to CAPD/CCPD Home Dialysis Patients 8 50.6.2  A3-3644.1  Payment for Hemodialysis Sessions8 50.7 PRM1-2702.2 Ultrafiltration8 50.8 A3-3112.6D HO-E212.1HO-E212.2, HO-E212.3, HO-E212.4 PRM1-2707,PRM1-2707.1 Training and Retraining8 50.9 A3-3644.5   RDF-319.3    Coding for Adequacy of Hemodialysis 8 60 PRM1-2711 Separa tely Billable ESRD Items and Services 8 60.1 A3-3644.1,A3-3167.3  B3-4270.2  RDF-322  PRM1-2711.1 Lab Services8 60.2 A3-3644F1-A3-3644F5   B3-2231  RDF-319.1    Drugs Furnished in Dialysis Facilities New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.2.1
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.2.1                                                                            Billing Procedures for Drugs forFacilities 8 60.2.2 AB-99-63 Drug Payment Amounts for Facilities 8 60.2.3  A3-3644 AB-02-005 Use of Additional Codes by Facilities to Report Drugs 8 60.2.4  A3-3644E  RDF-319.4 Intravenous Iron Therapy8 60.2.4.1  A3-3644 Facility Billing Requirements to the Intermediary  8 60.2.4.2  B3-4461.1B3-4461.2 B3-4461.3 Physician Billing Requirements to theCarrier 8 60.3 A3-3644G1-A3-3644G3    PRM1-2711.3   Blood and Blood Services Furnished in Hospital Based and Independent Dialysis Facilities 8 60.4 A3-3644D1-D3,  B3-2049.3B1, B3-2049.5B RDF-319,RDF-207.5A-C,   PRM1-2710.3A-D AB-00-76, A-01-106, AB 97-2  EPO8 60.4.1  A3-3644 PRM1-2710.3 EPO Facility Billing Requirements Using UB-92/Form CMS-1450 8 60.4.2 B3-4273.1  EPO Supplier Billing Requirements (Method II) on the Form CMS-1500 8 60.4.2.1  B3-4273.1      Other Information Required on the Form CMS-1500 New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.4.2.2
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.4.2.2                                                                                                  B3-4273.2  Completion of Subsequent FormCMS-1500 Claims for EPO 8 60.4.3  A3-3644 Payment Amount8 60.4.3.1  A3-3644 Payment in Other Settings8 60.4.3.2 A-01-106 Hospital Outpatient Departments8 60.4.4 B3-4270.1  Home Patients8 60.4.4.1 B3-4270.1  Self Administered EPO Supply8 60.5 PRM1-2711.6 Intradia lytic Parenteral/Enteral Nutrition (IDPN) 8 60.6     PRM1-2711.4   Hepatitis B Vaccine Furnished to ESRD Patients 8 70 A3-3644A3-3169 B3-4270.1  PRM1-2706.1E,  PRM1-2706.2,  RO2 3440.2 Payment for Home Dialysis 8 70.1 B3-4271 PRM1-2740.2 Method Selection for Home DialysisPayment 8 70.1.1 PRM1-2740.2D Change in Method8 70.2 PRM1-2740.3 Prevention of Double Billing Under Method I and II 8 70.3 PRM1-2740.4 OverpaymentsNew  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                        80 A3-3644A,A3-3169,  B3-4270 B3-4271 RDF-318  PRM1-2710,PRM1-2710.4,  RO2 3440 Home Dialysis Method I Billing to the Intermediary 8 80.1 A3-3169.1    PRM1-2712   Items and Services Included in the Composite Rate for Home Dialysis 8 80.2  A3-3644 CWF doc.   General Intermediary Bill Processing Procedures for Method I Home Dialysis Services 8 80.2.1  A3-3644.2  Requi red Billing Information for Method I Claims 8 80.3  A3-3112.6  PRM1-2709,PRM1-2709.1A,  PRM1-2709.2,   Calculating Intermediary Payment for Intermittent Peritoneal Dialysis (IPD) for Method I 8 80.3.1 PRM1-2709.1B   IPD at Home for Method I Claims Submitted to the Intermediary 8 80.4  A3-3644.1  PRM1-2709.2 Calculating Payment for ContinuousAmbulatory Peritoneal  Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD) Under the Composite rate 8 90 A3-3644A,A3-3644.3  B3-4270, B3-4271, B3-4270.1, B3-4270.2, B3-4271   PRM1-2740  RO2 3440C Method II Billing  New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                                                                  90.1 A3-3170.6,A3-3644.3,  A3-3644.3A-E   B3-2231.3A &B, B3-2231,  B3-4270.1,  HO-238.2C HO-238.3, HO-238.3A PRM1-2709.2A    DMERC Denials for Beneficiary Submitted Claims Under Method II 8 90.2 B3-4270.1,B3-3045.7  Requirements For Payment by theDMERC 8 90.2.1 B3-4270.1  Supplier Documentation Required8 90.2.2 B3-4270.1  DMERC Letter Explaining Requirementsto Method II Supplier 8 90.3  B3-3045.7    B-01-56   Amount of Payment by the DMERC 8 90.3.1 B3-3045.7  Billing Instructions for Method II to DMERCs 8 90.3.2  B3-4270    B-01-56  Home Dialysis Supplies and Equipment HCPCS Codes Used to Bill the DMERC 8 90.3.3 B3-3045.7C DMERC Claims Processing Instructions8 90.4 Equipment and Equipment RelatedServices Provided to Direct Dealing Beneficiary 8 90.5 A3-3644.3C,A3-3644.3D  PRM1-2740.1,PRM1-2743.1    Method II Support Services Billed to the Intermediary by the Facility  8 90.5.1  A3-3644.3E, RDF-321 Billable UB-92 Revenue Codes Under Method II 8 90.5.1.1  A3-3644.3E Unbillable UB-92 Revenue Codes Under Method II New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 100  A3-3169.3
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 100  A3-3169.3                                                                         RDF-245.2E  PRM1-2713 RO-23440.3,  Dialysis Sessions Furnished to Patients Who are Traveling 8 100.1     PRM1-2713.1   Traveling Patients Who are Normally In-facility Dialysis Patients 8 100.2 B3-4271.1,B3-4272 PRM1-2713.2, Traveling Patients Who are NormallyHome Dialysis  8 100.3 B3-4272.4  Physician's Services Furnished to aDialysis Patient Away from Home or Usual Facility 8 110 A3-3644c1,A3-3644c3,  PRM1-2706.2 Reduction in Medicare Program Paymentto Fund ESRD Networks 8 120  PRM1-2770 Renal Transplantation and RelatedServices 8 120.1 B3-4471 PRM1-2711.5,  AB-01-10 Payment for Immunosuppressive DrugsFurnished to Transplant Patients 8 130  B3-4270 Physicians and Supplier (non-facility)Billing for ESRD Services - General 8 130.1 B3-4275,B3-4275.1,  B3-4275.2 PRM1-2715,PRM1-2715.1, PRM1-2715.2    Initial Method for Physician's Services to Maintenance Dialysis Patients New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8
(Medicare Claims Processing Manual Crosswalk)
Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                                               140 B3-15060,B3-15060.1  B3-15060.2  B3-15060.3  B3-15060.4 B3-15060.5  B3-15350  B3-2230.3  B3-2230.6 B3-4272 B3-4272.1,  B3-4272.2 Monthly Capitation Payment Method forPhysicians' Services Furnished to Patients on Maintenance Dialysis 8 140.1 B3-4272.1  Services Included in Monthly CapitationPayment 8 140.2 B3-4272 Services Excluded from MonthlyCapitation Payment 8 140.3  B3-4272.2      Data Elements Required on Claim for Monthly Capitation Payment 8 140.4 B3-4272.3  Cont rolling Claims Paid Under the Monthly Capitation Payment Method 8 140.5 B3-15060.3 Determining Monthly CapitationPayment Amount for Physician's Services to Maintenance Dialysis Patients  8 140.5.1 B3-15060.4 Temporary Absence Under MCP8 150  B3-15060.5 Physician's Self-Dialysis TrainingServices New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                                       160 B3-15062.1,B3-4275  Payment for Physician's ServicesFurnished to Dialysis Inpatients 8 160.1 B3-15062.1 Determining Whether Physician ServicesFurnished on Day of Dialysis 8 160.2  B3-15062.1      Physicians' Services Furnished on Day of Dialysis 8 160.3 B3-15062.1 Physicians' Services Furnished on Non-Dialysis Days 8 160.4 B3-15062.1 Requirements for Payment8 170 B3-15350,R1810B3 Billing Physician Dialysis Services(codes 90935 - 90999) and Related Payment 8 180 AB-01-189,AB-03-001  Non-Invasive Studies for ESRD Patients - Facility and Physician Services
(Medicare Claims Processing Manual)
Medicare Claims Processing Manual  Chapter 9 - Rural Health Clinics/ Federally Qualified Health Centers   Table of Contents  (Rev. 1 2070, 06-07-23)  Transmittals for Chapter 9   10 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) General Information  10.1 - RHC General Information  10.2 - FQHC General Information  20 - RHC and FQHC All -Inclusive Rate (AIR) Payment System  20.1 - Per Visit Payment and Exceptions under the AIR  20.2 - Payment Limit under the AIR  30 - FQHC Prospective Payment System (PPS) Payment System  30.1 - Per -Diem Payment and Exceptions under the PPS  30.2 - Adjustments under the PPS  40 - Deductible and Coinsurance  40.1 - Part B Deductible  40.2 - Part B Coinsurance  50 - General Requirements for RHC and FQHC Claims  60 - Billing and Payment Requirements for RHCs and FQHCs  60.1 - Billing Guidelines for RHC and FQHC Claims under the AIR System  60.2 - Billing for  FQHC Claims Paid under the PPS  60.3 - Payments for FQHC PPS Claims  60.4 - Billing for Supplemental Payments to FQHCs  under Contract wit h Medicare Advantage (MA) Plans  60.5 - PPS Payments to FQHCs under Contract with MA Plans  60.6 - RHCs and FQHCs for Billing Hospice Attending Physician Services  70 - General Billing Requirements for Preventive Services  70.1 - RHCs Billing Approved Preventive Services  70.2 - FQHCs Billing Approved Preventive Services under the AIR  70.3 - FQHCs Billing Approved Preventive Services under the PPS  70.4 - Vaccines  70.5 - Diabetes Self  Management Traini ng (DSMT) and Medical Nutrition Services (MNT)  70.6 -  Initial Preventive Physical Examination (IPPE)   70.7  Virtual Communication Services  70.8  General Care Management Services  Chronic Care and Psychiatric Collaborative Care Model (CoCM) Services  80 - Telehealth Services  90 - Services Non -covered on RHC and FQHC Claims  100 -  Frequency of Bill ing and Same Day Billing
(Medicare Claims Processing Manual)
10 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) General Information  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)  10.1 - RHC  General Information  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)  RHCs are facilities that provide services that are typically furnished in an outpatient clinic setting.  The statutory requirements that RHCs must meet to qu alify for the Medicare benefit are in 1861(aa) (2) of the Social Security Act (the Act).   A RHC visit is defined as a medically -necessary, face -to-face (one-on-one) medical or mental health visit, or a qualified preventive health visit, with a RHC practitioner during which time one or more RHC services are rendered.  A RHC practitioner is a physician, nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW). A Transitiona l Care Management (TCM) service can also be a RHC visit.  A RHC visit can also be a visit between a home-bound patient and an RN or LPN under certain conditions.  RHCs can be either independent or provider-based.  Independent RHCs are stand- alone or freest anding clinics and submit claims to a Medicare Administrative Contractor (MAC).  They are assigned a CMS Certification Number (CCN) in the range of XX3800-XX3974 or XX8900-XX8999.  Provider-based RHCs are an integral and subordinate part of a hospital (including a critical access hospital (CAH), skilled nursing facility (SNF), or a home health agency (HHA)).   Information on RHC covered services, visits, payment policies, and other information can be found in Pub. 100- 02, Medicare Benefit Policy Manual, chap ter 13, http://www.cms.gov/Regulations- and-Guidance/Guidance/Manuals/Downloads/ bp102c13.pdf .
(Medicare Claims Processing Manual)
Information on certifica tion requirements can be found in Pub. 100- 07, Medicare State Operations Manual, Chapter 2, http://www.cms.gov/Regulations- and-Guidance/ Guidance/ Manuals/ Downloads/ som107c02.pdf .  10.2 - FQHC General Information  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)  FQHCs are facilities that provide services that are typically furnished in an outpatient clinic setting.  FQHC services consist of services that are similar to those furnished in RHCs.  The statutory requirements that FQHCs must meet to qualify for the Medicare benefit are in 1861(aa)(4) of the Act.  An entity that qualifies as a FQHC is assigned a CCN in the range of XX1000-XX1199 or XX1800-XX1989.  NOTE:   Information in this chapter applies to FQHCs that are Health Center Program Grantees and Health Center Program Look- Alikes.  It does not necessarily apply to tribal or urban Indian FQHCs or grandfathered tribal (GFT) FQHCs.   20 - RHC and FQHC All -Inclusive Rate (AIR) Payment System  (Rev. 3434, Issued: 12- 31-15, Effective: 03 -31-16, Implementation: 03 -31-16)  20.1 - Per Visit Payment and Exceptions under the AIR  (Rev. 3434, Issued: 12- 31-15, Effective: 03 -31-16, Implementation: 03- 31-16)  RHCs and FQHCs are paid an AIR per visit, except for FQHCs that have transitioned to the Medicare Pros pective Payment System (PPS).  For RHCs and FQHCs billing under the AIR, more than one medically- necessary face -to-face visit with a RHC or FQHC practitioner on the same day is payable as one visit, except for the following circumstances:
(Medicare Claims Processing Manual)
 The patient, subsequent to the first visit, suffers an illness or injury that requires additional diagnosis or treatment on the same day, (for example, a patient sees their practitioner in the morning for a medical condition and later in the day has a fall and returns to the RHC/FQHC);    The patient has a medical visit and a mental health visit on the same day;   The patient has an Initial Preventive Physical Examination (IPPE) and a separate qualified medical and/or mental health visit on the same day;    The pat ient has a Diabetes Self -Management Training (DSMT) or Medical Nutrition Therapy (MNT) visit on the same day as an otherwise payable medical visit.   DSMT and MNT apply to FQHCs only.  20.2 - Payment Limit under the AIR (Rev. 3434, Issued: 12- 31-15, Effecti ve: 03 -31-16, Implementation: 03- 31-16)  For RHCs and FQHCs that bill under the AIR, Medicare pays 80 percent of the RHC or FQHCs AIR, subject to a payment limit, except for RHCs that have an exception to the payment limit.  An interim rate for newly certified RHCs, and for FQHCs certified prior to October, 1, 2014, is established based on the RHCs or FQHCs anticipated average cost for direct and supporting services.  At the end of the cost reporting period, the MAC determines the total payment due and r econciles payments made during the period with the total payments due.
(Medicare Claims Processing Manual)
For FQHCs paid under the AIR, there is a payment limit for FQHCs located in an urban area and a payment limit for FQHCs located in a rural area.  Urban FQHCs are those located within a  Metropolitan Statistical Area (MSA). Rural FQHCs cannot be reclassified into an urban area (as determined by the Bureau of Census) for FQHC payment limit purposes.  If the FQHC organization includes both urban and rural sites and the FQHC organization files a consolidated cost report, the FQHC is paid the lower of the FQHC organizations AIR or a single weighted payment limit calculated for the entire FQHC organization.  The payment limit is weighted by the percentage of urban and rural visits as a percentage of total visits for the entire FQHC organization.  RHCs and FQHCs paid under the AIR are required to file a cost report annually in order to determine their payment rate.  If a RHC or FQHC is in its initial reporting period, the MAC calculates an interim rate based on a percentage of the per -visit limit, which is then adjusted when the cost report is filed.  For information on cost reporting requirements, see the Medicare Provider Reimbursement Manual (PRM), at http://www.cms.gov/Regulations- and-Guidance/Guidance/Manuals/Paper -Based -Manuals.html   30 - FQHC PPS Payment System  (Rev. 3434, Issued: 12- 31-15, Effective: 03 -31-16, Implementation: 03-31-16)  30.1 - Per-Diem Payment and Exceptions under the PPS  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)
(Medicare Claims Processing Manual)
30.1 - Per-Diem Payment and Exceptions under the PPS  (Rev. 3434, Issued: 12- 31-15, Effective: 03-31-16, Implementation: 03-31-16)  Section 10501(i)(3)(A) of the Affordable Care Act (Pub. L. 111-148 and Pub. L. 111-152) added section 1834(o) of the Social Security Act to establish a Me dicare PPS for FQHC services.  FQHCs transition to the Medicare PPS beginning on October 1, 2014, based on their cost-reporting period.  All FQHCs are expected to be transitioned to the PPS by December 31, 2015.  For FQHCs paid under the PPS, Medicare payment is based on the lesser of the FQHCs actual charge or the PPS rate, as determined by the MAC.  The FQHC PPS rate will be updated annually beginning January 1, 2016.  For FQHCs billing under the PPS, more than one medically- necessary face -to-face visit with a FQHC practitioner on the same day is payable as one visit, except for the following circumstances:   The patient, subsequent to the first visit, suffers an illness or injury that requires additional diagnosis or treatment on the same day, (for example, a patient sees their practitioner in the morning for a medical condition and later in the day has a fall and returns to the FQHC),
(Medicare Claims Processing Manual)
The patient has a medical visit and a mental health visit on the same day.   Separate payment is not made to FQHCs under the PPS for an IPPE or DSMT/MNT visit that is furnished on the same day as another FQHC medical visit.  30.2 - Adjustments under the PPS  (Rev. 3434, Issued: 12- 31-15, Effec tive: 03 -31-16, Implementation: 03-31-16)  The FQHC PPS rate will be adjusted to account for geographic differences in costs by the FQHC geographic adjustment factor (FQHC GAF).  In calculating the PPS rate, the FQHC GAF will be based on the locality of the site where the services are furnished.  For FQHC organizations with multiple sites, the FQHC GAF may vary depending on the location of the FQHC delivery site.  The FQHC PPS rate for a covered visit will be calculated as follows:   Base payment rate x FQHC  GAF = PPS rate   Updates to the FQHC GAFs will be made in conjunction with updates to the Physician Fee Schedule Geographic Practice Cost Indices for the same period and will be posted on CMSs FQHC PPS webpage at http://www.cms.gov/Medicare/Medicare -Fee-for-Service-Payment/FQHCPPS/index.html .  The PPS per -diem rate will be adjusted by a factor of 1.3416 when a FQHC furnishes care to a patient who  is new to the FQHC (has not been a patient at any site that is part of the FQHC organization within the previous 3 years) or to a beneficiary receiving an IPPE or an annual wellness visit (AWV).  This is a composite adjustment factor and only one adjustme nt per day can be applied.  If the patient is new to the FQHC, or the FQHC furnishes an Initial Preventive Physical Examination (IPPE) or Annual Wellness Visit (AWV), the FQHC PPS rate for a covered visit will be calculated as follows:   Base payment rate x FQHC GAF x 1.3416 = PPS rate