Provider Notice Issued 05/20/2020

Date:    May 20, 2020

To:       Federally Qualified Health Centers, Rural Health Centers, and Encounter Rate Clinics

Re:      Billing Procedures for Fee-For-Service Reimbursement and Telehealth Billing Clarification

This notice provides clarification of billing instructions to Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs) for fee-for-service (FFS) reimbursement of Long-Acting Reversible Contraceptives (LARCs), FFS reimbursement of virtual check-in and e-visit services billable during the COVID-19 public health emergency, and telehealth services. These instructions do not apply to claims for participants covered under HealthChoice Illinois managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans.  

Fee-For-Service (FFS) Billing

FQHCs, RHCs, and ERCs billing for FFS reimbursement of LARCs at the Practitioner Fee Schedule rate, as well as virtual check-in and e-visit services at the FFS rate indicated on the COVID-19 Virtual Healthcare Expansion Billing Codes fee schedule found on the COVID-19 Updates webpage, must adhere to the following guidelines for proper reimbursement:

• Report only the applicable CPT or HCPCS procedure code, without reporting the T1015 encounter code. 

• Report one of the following taxonomy codes in billing loop 2010AA, in accordance with the Chapter 300 Taxonomy table for 837P, in order for the clinic to be correctly identified as the provider of record for FFS reimbursement:

o   261QF0400X (FQHC)

o   261QR1300X (RHC)

o   261QP2300X (ERC)

Additional detailed reimbursement criteria specific to FFS billing of LARCs is also found in Topic 210.5.2 of the Handbook for Providers of Encounter Clinic Services.

Telehealth Billing

The March 30, 2020 provider notice regarding telehealth expansion billing instructions incorrectly stated that medical encounter claims must include the GT modifier on only the detail code service lines. To clarify, for both medical and behavioral health encounters, the claim must include the GT modifier on all service lines, including the T1015 encounter service line as well as all detail code service lines. As a reminder, for behavioral health encounters, the behavioral health modifier must be the first modifier appended to the T1015 encounter code in order for the claim to price correctly.

Questions regarding this notice may be directed to a physician billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

Kelly Cunningham

Interim Medicaid Administrator