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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 2. Medicaid Title XIX family planning services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.2 Other Family Planning Office or Outpatient Visits : 2.2.2.1 FQHC Reimbursement for Other Family Planning Office or Outpatient Visits

2.2.2.1
FQHCs may be reimbursed for three family planning encounters per year, per client, regardless of the reason for the encounter. The three encounters may include any combination of general family planning, annual family planning exams, or services (procedure code J7300, J7302, or J7307).
A family planning diagnosis code must be billed along with the most appropriate informational procedure codes for the services that were rendered. Reimbursement for services payable to an FQHC is based on an all-inclusive rate per visit.
Refer to:
Section 4, “Federally Qualified Health Center (FQHC)” in the Clinics and Other Outpatient Facility Services Handbook, (Vol. 2, Provider Handbooks) for more information about FQHC services.

Texas Medicaid & Healthcare Partnership
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