MedicaidReimbursementMedium impact
Clarification of Reimbursement for Primary Care Services with Carved-Out Diagnosis Codes in Federally Qualified Health Centers
Maryland Medicaid·MD · Family Medicine, General Practice, Internal Medicine +1 more·Behavioral Health Administration Services Organization
Effective date
May 24, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid MCOs must now reimburse FQHCs when primary care providers bill for services using carved-out behavioral health diagnosis codes, as long as the service is within the PCP's scope of practice. This clarifies that PCPs at FQHCs can use behavioral health ICD-10 codes that are normally carved out for specialty behavioral healthcare.
Action Required
Immediately: FQHC billing teams in Maryland should update billing procedures to ensure primary care providers can bill MCOs for services using carved-out behavioral health ICD-10 diagnosis codes when services are within PCP scope of practice. Train billing staff that these claims should be submitted to MCOs rather than carved out to behavioral health organizations. Update billing system rules to allow MCO billing for these scenarios.