5101:3-28-11 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 therapypathology 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 whichthat 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: 07/01/2006
R.C. 119.032 review dates: 03/09/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 10/1/03