Wiki FQHC and IBT

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smaher82

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A question has come up by our registered dietician about who can do Intensive behavioral therapy for obesity. Medicare B clearly stated that's a RD can bill incident to. However we are FQHC and Bill Medicare A for our preventative services. We thought only a provider could but she is insisting RD's can.

Does anyone have any information on this or billing this at their FQHC practice?

TIA
 
Thank you!! We do have this but I'm not sure what they mean when they talk about profession vs technical. Would we bill the g0447 with a tc or 26? Both staff members ( RD and MD ) are employed by us so I thought this would be global? I don't understand what they are saying.


Is anyone else billing for this service and a FQHC or maybe they can make sense of below?

Additional Billing Instructions for FQHCs and RHCs
The professional component of preventive services is within the scope of covered FQHC or RHC
services. The professional component is a physician?s interpretation of the results of an examination.
For instructions on billing the professional component, visit http://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1039.pdf
on the CMS website.
The technical component is services rendered outside the scope of the physician?s interpretation
of the results of an examination. If you perform technical components or services, not within the
scope of covered FQHC or RHC services, in association with professional components, how you
bill depends on whether the FQHC or RHC is independent or provider-based:
► For Provider-Based FQHCs or RHCs: Bill the technical
component of the service on the TOB for the base provider
and submit to the FI or A/B MAC in the 837-I format.
For more information on billing instructions for providerbased
FQHCs or RHCs, visit http://www.cms.gov/
Regulations-and-Guidance/Guidance/Manuals/Internet-
Only-Manuals-IOMs-Items/CMS018912.html on the CMS
website and choose the appropriate chapter based on your
facility type.
► For Independent FQHCs or RHCs: Bill the technical
component of the service to the carrier or A/B MAC in the
837-P format. For more information on billing instructions
for independent FQHCs or RHCs, visit http://www.cms.gov/Regulations-and-Guidance/
Guidance/Manuals/Downloads/clm104c12.pdf and http://www.cms.gov/Regulations-and-
 
G0447 does not need a modifier. You would only append the place of service code.

11-Physician?s Office

22-Outpatient Hospital

49-Independent Clinic

71-State or local public health clinic
 
I believe for an FQHC any service you bill to Medicare for your all inclusive/PPS rate, the service must be provided by a core provider. An RD is not a core provider. FQHC covered core practitioners: physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, or clinical social workers.
 
We are a provider based FQHC with a RD on staff also. Will bill only for MNT services. I believe when our new RD started she was talking about group therapy and IBT for obesity also. I believe as a FQHC, we can only bill for MNT or DSMT services, for one-on-one, face-to-face visits. For use 97802/3 for MNT. I don't think she's billed a DSMT visit yet. We do not bill incident to, we bill under the RD's NPI to Part A, and we are getting paid. We do use POS code 11, not 50, and I don't know if that might make a difference.

I actually was wondering what other provider based FQHCs are using for their POS code with all their providers. We have been told by consultants that we should be using 50, and by code definition that is correct. The other FQHCs in our area that we asked are all using POS 11. What do you use, and where are you located?

Arrana Ashton, CPC, CEMC
Lead Medical Coder
Outer Cape Health Services
Wellfleet, MA
 
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