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FQHC and rural health clinic billing, done the encounter way
Billing for federally qualified health centers and rural health clinics: Medicare encounter rates, FQHC G-codes, Medicaid PPS and more.
How FQHC and RHC billing works
FQHCs and RHCs are paid per encounter, not per service. Medicare pays FQHCs under the FQHC prospective payment system, billed on the 837I with type of bill 77x and FQHC payment codes G0466–G0470. RHCs bill with type of bill 71x and are paid an all-inclusive rate.
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Medicaid pays health centers a state PPS or alternative rate, and managed care payments often require a wraparound payment from the state.
Codes we bill every day
| Code | What it covers |
|---|---|
| TOB 77x | FQHC claims |
| TOB 71x | RHC claims |
| G0466 / G0467 | FQHC new and established patient visits |
| G0469 / G0470 | FQHC mental health visits, new and established |
| Rev 0521 | Clinic visit by a member to the RHC or FQHC |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Missing FQHC payment code paired with qualifying services
- Services that do not count as a billable encounter
- Wraparound claims not filed with Medicaid
- Visits by non-qualifying practitioners
- Same-day medical and mental health visits billed wrong
Questions about FQHC and RHC billing
Do you handle Medicaid wraparound claims?
Yes. We reconcile managed care payments and file wraparound claims where your state requires them.
Get a free FQHC and RHC billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.