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PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines
Act
by Mar 3, 2026
Effective date
Mar 3, 2026
Identified
Jun 18, 2026
Summary
Maryland Medicaid has updated coding guidelines for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), clarifying billing procedures for multiple encounters per day and specifying different trigger codes for MCO versus Fee-for-Service claims. The policy details specific submission requirements for somatic, mental health, substance abuse, and dental services.
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What to do
by Mar 3, 2026 · 5 steps
01FQHC and RHC billing teams must update billing systems to use correct trigger codes based on payer type - use Encounter Data Trigger Codes for MCO claims and Fee-for-Service Trigger Codes for Medicaid FFS claims.
02Ensure all additional services on same visit are billed at $0.00 charge except the trigger code line which reflects cost per visit rate.
03Update system to route behavioral health claims to Carelon ASO and dental claims to SKYGEN ASO.
04For Medicare secondary claims, mandate use of T1015 code with exact matching charges to Medicare EOB.
05Configure system to prevent use of FQHC/RHC numbers for inpatient hospital services.
Codes mentioned
T1015920029200492012920149920199202992039920499205992119921299213992149921599241992429924399244992459930499305993069930799308993099931099315993169931899324993259932699327993289933499335993369933799339993409934199342993439934499345993479934899349993509938199382993839938499385993869938799391993929939399394993959939699397978029780397804G01081197511976119811198211983594309079190832908349083790836H0001H0004H0015H0016H0020H0047D0999
Original notice
PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines
health.maryland.gov · Always check the source before changing claims.
Related changes
See all Maryland Medicaid changes →PT 88-25: Primary Care Investment: E&M IncreasesHighEffective Aug 1, 2025 · Managed CareFederally Qualified Health Center and Rural Health Center Coding GuidelinesMediumNo effective date · FQHCGeneral Provider TransmittalMediumNo effective date · General ProviderProposed HealthChoice AmendmentsMediumEffective Jan 1, 2003 · Managed Care OrganizationsBrowse every Maryland Medicaid change in the policy list
Related policy hubs
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