Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are safety-net providers that offer outpatient services. FQHCs include community health centers, migrant health centers, health care for the homeless centers, public housing primary care centers, and health center service “lookalikes.”

Below are resources specific to billing and reimbursement for DSMES in FQHCs:

Geographic Adjustment Factors for FQHC:
There is one national, unadjusted “base” prospective payment system (PPS) rate for the FQHC-approved qualifying visit codes for all FQHCs. The rate is $176.45 (January through December 2021). CMS updates this rate annually to reflect inflation and adjusts for each FQHC based on the facility’s location (referred to as the “geographical adjustment factor” or GAF).

Medicare Claims Processing Manual [PDF – 241 KB]:
This is a direct link to Chapter 9, which covers FQHCs.

Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS) [PDF – 323 KB]:
This link describes specific payment codes for FQHCs, including for DSMT.