Federally Qualified Health Center PPS
Guidance for how payment is made for Medicare services furnished at Federally qualified health centers. FQHCs began transitioning to a prospective payment system (PPS) in which Medicare payment is made based on a national rate which is adjusted based on the location of where the services are furnished.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: November 13, 2019
Overview
Section 10501 of the Patient Protection and Affordable Care Act of 2010 modified how payment is made for Medicare services furnished at Federally qualified health centers (FQHCs). On October 1, 2014, FQHCs began transitioning to a prospective payment system (PPS) in which Medicare payment is made based on a national rate which is adjusted based on the location of where the services are furnished. The rate is increased by 34.16 percent when a patient is new to the FQHC, or an Initial Preventive Physical Exam (IPPE) or Annual Wellness Visit (AWV) is furnished. Please visit the FQHC Center page, a one-stop resource, for more information on understanding the methodology and payment rates for the new FQHC PPS.
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