Federally Qualified Health Centers

medical clinic sign

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 diabetes self-management education and support (DSMES) services 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 $187.19 (based on data as of June 2022). 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

Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS)