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FQHC and RHC Provider Manual Update

South Dakota Medicaid has posted a new version of the Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Provider Manual. The manual has been updated to include a list of medical procedure codes that are considered a Prospective Payment System (PPS) visit. These services are reimbursed at the provider’s per diem rate.

PPS visits are limited to certain types of providers and services as stated in the provider manual. Providers bill for these services under their FQHC or RHC billing NPI and are reimbursed at a per diem rate for all services rendered. The provider manual provides details regarding when multiple visits may be billed for one recipient for the same date of service.

The manual now includes a list of codes that can be billed under the FQHCs or RHCs billing NPI and generate a per diem payment. Previously the manual only described what services were reimbursed at the per diem rate, but did not include a list of applicable procedure codes. Providers should continue to refer to the Dental Services Fee Schedules for a list of dental services reimbursable at the per diem rate.

Read the memo from South Dakota Medicaid here.

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