Are there specific DSME billing considerations for FQHC / RHC?

Find out more about billing for Federal Qualified Health Centers and Rural Health Clinics.

Individual DSME services furnished by a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) are paid under the Prospective Payment System (PPS). As such, they have unique billing considerations.

When furnished by a physician, advanced practice registered nurse, physician assistant, or pharmacist, an FQHC or RHC may submit a claim for individual DSME services under the PPS using T1015 with a U1 modifier along with the appropriate procedure codes (G0108 and G0109).

DSME service furnished by a dietitian is paid under the FQHC or RHC’s ambulatory health care clinic provider number (provider type 50).

Group DSME services do not meet the criteria for a face-to-face visit, and therefore, FQHCs or RHCs rendering group DSME services may submit claims for group DSME services to Ohio Department of Medicaid using their ambulatory health care clinic provider number (provider type 50).

Access Ohio Department of Medicaid FQHC / RHC DSME billing guidelines >