MedicaidBilling CodesHigh impact
Billing update for FQHCs and RHCs
Geisinger Health Plan·Claims
Effective date
Mar 1, 2025
We identified it
Jul 29, 2026
Summary
Effective March 1, 2025, FQHCs and RHCs can no longer bill T1015 (Clinic Visit/Encounter, All-Inclusive) as a standalone code. Claims must now include a qualifying E/M or HCPCS service code describing the actual services provided. T1015-only claims will be denied with CARC 129/RARC 130 and are non-appealable unless resubmitted with complete information.
Action Required
By March 1, 2025: Billing team must update claim submission workflows to REQUIRE a qualifying E/M or HCPCS service code on every claim containing T1015 for GHP Kids (CHIP) and GHP Family (Medicaid) plans. Add validation rules to billing system to prevent submission of T1015-only claims. Update provider/staff training materials to clarify that T1015 is all-inclusive and must be paired with appropriate evaluation and management codes. Establish audit process to identify any T1015-only claims currently in inventory and resubmit with qualifying codes before effective date. Failure to comply will result in claim denials with no appeal rights; claims will be returned as unprocessable.