Place of Service Billing for Services in FQHCs and RHCs
| Date: | September 27, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) |
| From: | Health Plan of San Joaquin (HPSJ) |
| Type: | Regulatory |
| Subject: | Place of Service Billing for Services in FQHCs and RHCs |
| Business: | Medi-Cal Managed Care |
Effective December 1, 2023, claims for payment of services that do not accurately reflect the appropriate POS codes will be denied as an invalid place of service. To ensure a smooth claims process, please take note of the following guidelines:
Place of Service Code Requirements
When billing CPT and HCPCS codes, it is essential that FQHCs and RHCs bill correctly with the appropriate Place of Service Code on the claim form.
- For services provided by Federally Qualified Health Centers (FQHC), please enter Place of Service Code 50 in Block 24B (Place of Service) on the CMS 1500 claim
form. - For services provided by Rural Health Clinics (RHC), please enter Place of Service Code 72 in Block 24B (Place of Service) on the CMS 1500 claim form.
Please note that Place of Service codes 11 (Office) or 99 (Other Place of Service) are not accepted when rendering service in an FQHC or RHC setting. For additional information or resources related to these coding requirements, please visit the CMS website and the following link:
Medicare Claims Processing Manual (cms.gov)
We appreciate your attention to this matter and your commitment to maintaining the accuracy and integrity of our claim’s submissions. Thank you for your continued partnership and cooperation.
Our team is here to provide support and ensure a smooth transition to these new guidelines. If you have any further questions regarding this update, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.