FQHC BH Billing — 2026 Guide
FQHC PPS Rate Basics
- Prospective payment per encounter (all-inclusive)
- Rate based on FQHC cost reports + Medicare/Medicaid rules
- PPS-1 (daily) vs PPS-2 (monthly) methodologies
- Includes BH visit + medical visit if same day
Sliding Fee Scale Requirements
- HRSA-required for FQHC/FQHC LAL status
- Nominal fee for under 100% FPL
- Discount sliding to 200% FPL
- Documentation required per patient
- Cannot deny service for inability to pay
Common Billing Issues
- Same-day BH + medical encounter billing (payer-specific)
- Encounter definition (must meet threshold)
- Non-face-to-face services (varies by state)
- Care coordination billing
- Substance use screening (SBIRT) billing
– KD, Revenant Care