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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 2 Healthy Texas Women (HTW) Program Overview : 2.3 * Services, Benefits, Limitations, and Prior Authorization : 2.3.3 Other Family Planning Office or Outpatient Visits : 2.3.3.1 * FQHC Reimbursement for Other Family Planning Office or Outpatient Visits

2.3.3.1
FQHCs may be reimbursed for three encounters per HTW client, per year. Procedure codes J7297, J7298, J7300, J7301, and J7307 may be reimbursed in addition to the FQHC encounter payment. When seeking reimbursement for an IUD or implantable contraceptive capsule, providers must submit on the same claim the procedure code for the contraceptive device along with the procedure code for the encounter. The contraceptive device is not subject to FQHC limitations. Providers must use modifier U8 when submitting claims for a contraceptive device purchased through the 340B Drug Pricing Program.
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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