MedicaidCoverageMedium impact
Coverage of CenteringPregnancy and HealthySteps Enhanced Payments for FQHCs
Maryland Medicaid·MD · OB-GYN, Family Medicine, Pediatrics·Provider Transmittal
Effective date
Nov 13, 2023
We identified it
Jun 20, 2026
Summary
This Maryland Medicaid policy clarifies that Federally Qualified Health Centers (FQHCs) implementing CenteringPregnancy and HealthySteps programs are NOT eligible to bill for enhanced payments due to the Prospective Payment System. FQHCs may participate in these maternal-child health programs but cannot claim the enhanced reimbursement codes available to other providers. No ePREP system changes are required for FQHCs administering these programs.
Action Required
If your practice is an FQHC in Maryland: (1) Verify with your billing team that CenteringPregnancy and HealthySteps enhanced payment codes are NOT included in any billing templates or submission workflows, as FQHCs are explicitly ineligible to bill these enhanced payments; (2) Do NOT attempt to submit claims for CenteringPregnancy or HealthySteps enhanced payments to Maryland Medicaid MCOs, as they will be denied due to FQHC Prospective Payment System restrictions; (3) Ensure clinical staff understand that participation in these programs is allowed, but billing is limited to standard FQHC encounter rates; (4) Direct any questions about program enrollment or eligibility to mdh.medicaidmch@maryland.gov. No ePREP portal updates are needed by FQHCs. Reference PT 30-23 for the original CenteringPregnancy and HealthySteps coverage policy.