MedicaidBilling CodesHigh impact
PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines
Maryland Medicaid·MD · Family Medicine, Internal Medicine, General Practice +3 more·Coding
Effective date
Mar 3, 2026
We identified it
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.
Action Required
By March 3, 2026: FQHC 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. Ensure all additional services on same visit are billed at $0.00 charge except the trigger code line which reflects cost per visit rate. Update system to route behavioral health claims to Carelon ASO and dental claims to SKYGEN ASO. For Medicare secondary claims, mandate use of T1015 code with exact matching charges to Medicare EOB. Configure system to prevent use of FQHC/RHC numbers for inpatient hospital services.