Copayment for FQHC Preventive Health Services

220.4 - Copayment for FQHC Preventive Health Services (Rev. 239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18) Under the FQHC PPS, coinsurance will generally be 20 percent of the lesser of the FQHC’s charge or the PPS rate. When one or more qualified preventive services are provided as part of an FQHC visit, the A/B MAC will use the lesser of the FQHC’s charge for the specific FQHC payment code or the PPS rate to determine the total payment amount. To determine the amount of Medicare payment and the amount of coinsurance that should be waived, the A/B MAC will use the FQHC’s reported line- item charges and subtract the dollar value of the FQHC's reported line-item charge for the preventive services from the full payment amount. For FQHC claims that consist solely of preventive services that are exempt from beneficiary coinsurance, Medicare pays 100 percent of the lesser of the FQHC’s charge or the FQHC PPS rate, and no beneficiary coinsurance is assessed.