MedicaidBilling CodesHigh impact
FQHC and RHC Billing Guidelines for Postpartum
Arkansas Medicaid·AR · OB-GYN, Family Medicine, General Practice·Claims & Billing
Effective date
Jul 1, 2025
We identified it
Apr 24, 2026
Summary
Arkansas Department of Human Services amended billing guidelines for FQHCs and RHCs to use dedicated postpartum encounter codes (T1015 with U5 or U2 modifiers and TH modifier) instead of E&M codes, allowing reimbursement at the encounter rate and bypassing the 16-visit per fiscal year limit when billed with diagnosis group 2038.
Action Required
By July 1, 2025: Billing team must immediately update billing system configuration to use T1015 U5 TH for FQHC postpartum encounters and T1015 U2 TH with revenue code 520 or 521 for RHC postpartum encounters. Configure system to require diagnosis codes from group 2038 when billing these code/modifier combinations. Update provider encounter forms and billing workflows to reflect new postpartum billing requirements. Configure system to bypass the 16-visit per SFY limit for these specific code/modifier combinations. Disable or remove E&M postpartum codes from available options for FQHC and RHC claims. Train billing staff on new requirements. Failure to implement changes will result in claims being denied or incorrectly processed. Note: Previously submitted FQHC claims will be adjusted in cost settlement; RHC claims do not require rebilling.