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Effective November 1, 2023: Telemedicine and Telehealth Benefit Updates for RHCs and FQHCs

Date: 11/28/23

Superior HealthPlan would like to provide guidance on the implementation of a new telehealth patient site facility fee benefit for Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers.

Telehealth services are defined as health-care services, other than telemedicine, medical services or a teledentistry service, delivered by a healthcare professional licensed, certified or otherwise entitled to practice in Texas; acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location other than the health professional using telecommunications or information technology. As a reminder, guidance regarding the telemedicine patient site facility fee benefit for RHCs was implemented on April 1, 2022.

Effective for dates of service on or after November 1, 2023, FQHC and RHC providers performing patient-site telehealth services may be reimbursed for the facility fee (procedure code Q3014) as an add-on procedure code.

Procedure code Q3014 is a benefit for FQHC and RHC providers when telehealth services are rendered in the office or outpatient hospital setting.

Please Note:

  • For FQHCs, the facility fee should not be included in any cost reporting that is used to calculate a Prospective Payment System (PPS) or Alternative Prospective Payment System (APPS) per visit encounter rate.
  • For RHCs, the facility fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) PPS per visit encounter rate.
  • For more than one facility fee for the same client on the same date of service may be reimbursed for multiple distant-site provider consultations, when medically necessary.
  • If an FQHC or RHC is eligible for the payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC or RHC must submit a claim for the facility fee separately from the claim that was submitted for the encounter.

Clarifications for Telemedicine and Telehealth

  • FQHC practitioners may be employees or contracted with the FQHC.
    • The same applies for RHC practitioners.
  • A distant-site provider that is located outside of state lines while rendering services are considered an out-of-state provider.

For more information, please reach out to your local Account Manager. To access their contact information visit Find My Account Manager.