CHC and FQHC Coding Tips
Maximize reimbursement and compliance with these essential coding tips for Community Health Centers (CHCs) and
Federally Qualified Health Centers (FQHCs).
Provider Education: Small Changes, Big Impact
Tip: Simple tweaks – such as a clear assessment, proper diagnosis linkage, and a concise plan – can significantly reduce coder queries, denials, and rework.
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April 28, 2026
Denials Workflow: Coding vs. Billing Responsibility
Tip: Before appealing FQHC denials, always confirm: 1. Coding guidelines – Was the CPT/ICD selection correct? 2. Payer policy – Does the payer cover the
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April 13, 2026
Modifier Use in FQHCs: Less Is More
Tip: Modifiers should be used intentionally and consistently – not as a workaround for payment issues. Appropriate modifier use supports compliance, improves claim accuracy, and
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March 30, 2026
Preventive Visits: What Can (and Can’t) Be Included
Tip: Preventive visits (993XX) do not qualify as FQHC PPS encounters. Coding must reflect medical necessity, not just the services documented. Watch For: 1. Minor
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March 17, 2026
Labs & Screenings: Coding vs. Payer Policy
Tip: Correct CPT coding does not always guarantee payment. For labs – such as A1c, lipid panels, or routine screenings – the diagnosis code must
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February 16, 2026
Same-Day Visits: Behavioral Health + Problem Visit
Tip: In FQHCs, two separate visits on the same day – such as a behavioral health encounter and a problem-oriented medical visit – can be
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February 2, 2026
Medical Necessity Drives PPS – Not Just Documentation
In FQHCs, medical necessity – not the number of services performed – determines whether a visit qualifies as a PPS encounter. Simply performing multiple services
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January 21, 2026
2026 FQHC Coding Tip #1: FQHC vs. Non-FQHC Encounters: A Common Risk Area
One of the most common challenges we see in FQHC coding is distinguishing between PPS encounters and non-FQHC services. Coding must align with how the
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January 8, 2026
Coding Tip of the Week: Understanding “Code First” Rules in Behavioral Health
Coding Tip of the Week: Understanding “Code First” Rules in Behavioral Health
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December 16, 2025
FQHC Coding Tip for the week: FQHC Medicaid Denials: Why They Happen and How to Prevent Them
One of the biggest challenges Federally Qualified Health Centers (FQHCs) face is navigating Medicaid denials. Each state’s Medicaid program operates differently – with its own
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September 2, 2025
FQHC Billing Tip: Understanding Professional & Technical Components for Medicare Claims
Did you know? In FQHCs, CPT codes that have both professional and technical components must be split using modifiers 26 and TC – especially when
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July 29, 2025
FQHC Medicare Tip: Two Visits on the Same Day
Did you know Medicare does allow additional payment for a second visit on the same day – but only under specific conditions? If a patient
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July 14, 2025
The definition of a “new patient” isn’t the same across the board
According to CPT (AMA), a new patient is one who hasn’t received professional services from the provider (or another provider in the same specialty &
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July 7, 2025
Focus: Maternity Coding in an FQHC/CHC Setting
Did you know that FQHCs (Federally Qualified Health Centers) and CHCs (Community Health Centers) follow a different billing methodology for maternity care compared to hospitals
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June 30, 2025
Coding Tip of the Week – Don’t Let Insurance Mismatches Derail Your Claims
Did you know that coding based solely on EMR entries-without verifying insurance details-can lead to costly denials for FQHCs? ✅ Always align coding with the
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June 24, 2025
CHC and FQHC Tip for the Week: Let’s talk about coding accuracy for healthcare!
Ensure the CPT and ICD codes match the patient’s age for precise billing and care. Here are key examples: ✅ CPT Codes: 1) 90700: DTaP
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June 16, 2025
CHC and FQHC Tip for the Week: FQHC- IS YOUR DATE OF SERVICE CAUSING THE DENIAL?
In an FQHC/CHC setting, when a patient has dual insurance, an incorrect date of service (DOS) can often lead to a denial from the secondary
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June 10, 2025
CHC and FQHC Tip for the Week: You’ve double-checked the ICD and CPT codes.
Everything looks accurate. But then – the claim is denied. The denial cites a coding issue. And yet, your coding team confirms, “Everything seems fine.”
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June 2, 2025
Weekly Tip for FQHCs: Submitting Medicare claims under PPS?
Don’t forget: Each payment code (like G0466–G0470) must be paired with a qualifying visit code on a separate line. Here’s your go-to reference for 2024
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May 19, 2025
WEEK #1 FQHC/CHC Coding Tip: Mastering EKG Coding for Medicare
Navigating EKG coding in Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs)? Here’s a quick guide to ensure compliance and accuracy: 🔹 CPT
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May 12, 2025