5160-28-11 Federally qualified health centers (FQHCs): billing for FQHC services.  

  • Text Box: ACTION: Final Text Box: DATE: 09/19/2016 11:00 AM

     

     

     

    TO BE RESCINDED

     

    5160-28-11                  Federally qualified health centers (FQHCs): billing for FQHC services.

     

     

     

    (A)  For services provided on or after October 1, 2003, FQHCs shall include the following data elements unique for FQHC billings:

     

    (1)   The code T1015.

     

    (2)   The code to specify the type of encounter provided, e.g., T1015U1:

     

    (a)   For a medical encounter, use the modifier U1;

     

    (b)   For a dental encounter, use the modifier U2;

     

    (c)   For a mental health encounter, use the modifier U3;

     

    (d)  For a physical therapy encounter, use the modifier U4;

     

    (e)   For a speech pathology encounter, use the modifier U5;

     

    (f)  For a podiatry encounter, use the modifier U6;

     

    (g)   For an optometric and/or optician services encounter, use the modifier U7;

     

    (h)   For a chiropractic encounter, use the modifier U8; and

     

    (i)   For a transportation encounter, use the modifier U9.

     

    (3)   All procedure codes that describe the services provided during the encounter.

     

    (B)    If the services is provided on or after October 1, 2003 and the claim is for a supplemental payment, follow the applicable instructions found in this rule addressing coding and modifiers. In addition, submit the unique data elements required for a supplemental payment found in rule 5101:3-28-07 of the Administrative Code.

     

    (C)      For consumers in the medicaid managed care program, claims submission requirements, including prior authorization requests for FQHC services as defined in   Chapter   5101:3-28   of   the   Administrative   Code   are   specified   in   rules

     

     

     

    5101:3-26-03.1 and 5101:3-26-05.1 of the Administrative Code.

    Effective:

    10/01/2016

    Five Year Review (FYR) Dates:

    02/10/2016

     

    CERTIFIED ELECTRONICALLY

     

    Certification

     

     

    09/19/2016

     

    Date

     

     

    Promulgated Under:

     

    119.03

    Statutory Authority:

    5164.02

    Rule Amplifies:

    5162.03, 5164.02, 5164.70

    Prior Effective Dates:

    10/01/2003, 07/01/2006

Document Information

Effective Date:
10/1/2016
File Date:
2016-09-19
Last Day in Effect:
2016-10-01
Five Year Review:
Yes
Rule File:
5160-28-11_PH_FF_R_RU_20160919_1100.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160-28-11. Federally qualified health centers (FQHCs): billing for FQHC services