Federally Qualified Health Center Billing Codes. Effective January 1, 2017

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1 Federally Qualified Health Center Billing Codes Effective Adult Health Screening Codes Adult Health Screening, new patient, age yrs. Cost based Adult Health Screening, new patient, age yrs. Cost based Adult Health Screening, new patient, age 65 yrs. and over Cost based Adult Health Screening, established patient, age yrs Adult Health Screening, established patient, age yrs Adult Health Screening, established patient, 64 yrs. and over Cost based Cost based Cost based Chiropractic Services Codes New Patient Visit 98940, 98941, Chiropractic Manipulation 98942

2 Child Health Check-Up Codes CODE MODIFIER DESCRIPTION OF SERVICES MAXIMUM FEE Child Health Check-Up Screening new patient <1year Child Health Check-Up Screening new patient 1 through 4 years Child Health Check-Up Screening new patient 5 through 11 years Child Health Check-Up Screening new patient 12 through 17 years EP Child Health Check-Up Screening new patient 18 through 20 years Child Health Check-Up Screening established patient <1 year Child Health Check-Up Screening established patient 1 through 4 years Child Health Check-Up Screening established patient 5 through 11 years Child Health Check-Up Screening established patient 12 through 17 years EP Child Health Check-Up Screening established patient 18 through 20 years Dental Services Codes D0150 Comprehensive Oral Evaluation D0120 Periodic Oral Evaluation Cost based D5211 Upper Partial-Resin Base * D5212 Lower Partial-Resin Base * D5213 Maxillary Partial Denture * D5214 Mandibular Partial Denture * D5820 Interim Partial Denture *

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4 Family Planning Codes CODE MODIFIER DESCRIPTION OF SERVICES MAXIMUM FEE FP Family Planning Initial Family Planning Examination age 5-11 years FP Family Planning Initial Family Planning Examination age years FP Family Planning Initial Family Planning Examination age years FP Family Planning Initial Family Planning Examination age years FP Family Planning Annual Family Planning Examination age 5-11 years FP Family Planning Annual Family Planning Examination age years FP Family Planning Annual Family Planning Examination age years FP Family Planning Annual Family Planning Examination age years FP Family Planning Counseling Visit FP Family Planning Supply Visit HIV Counseling

5 Family Planning Waiver Codes CODE MODIFIER DESCRIPTION OF SERVICES MAXIMUM FEE FP Family Planning Initial Family Planning Examination age 5-11 years FP Family Planning Initial Family Planning Examination age years FP Family Planning Initial Family Planning Examination age years FP Family Planning Initial Family Planning Examination age years FP Family Planning Annual Family Planning Examination age 5-11 years FP Family Planning Annual Family Planning Examination age years FP Family Planning Annual Family Planning Examination age years FP Family Planning Annual Family Planning Examination age years FP Family Planning--Supply Visit FP Family Planning--Counseling Visit 99401, HIV Counseling Primary Medical Care Codes Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit Office or other outpatient visit H1000 Antepartum Care only Postpartum Care only

6 Mental Health Services Code CODE DESCRIPTION MAXIMUM FEE H0004 Optometric Services Codes Individual and/or Group Therapy by Mental Health Practitioner ( minutes) CODE DESCRIPTION MAXIMUM FEE Optometric Care-New patient Optometric Care-Established patient Podiatry Services Codes CODE DESCRIPTION MAXIMUM FEE See Primary Medical Care for descriptors. Immunization Codes Administration of Vaccines to Medicaid recipients from birth through 18 years $5.50 per vaccine dose