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Federally Qualified Health Center and Rural Health Center Coding Guidelines
Effective date
Not stated in the notice
Identified
Sep 29, 2026
Summary
Maryland Medicaid's March 3, 2026 FQHC and Rural Health Clinic transmittal reminds billers of existing rules: one encounter per recipient per day for each of somatic, mental health, substance use disorder and dental services, with the trigger code carrying the organization's cost-per-visit rate and other services listed at $0.00. The trigger codes and payer routing differ for MCO, Medicaid fee-for-service, behavioral health and dental claims, so each claim must follow the rule for its payer.
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What to do
Action · 12 steps
01Reminder of existing rules, with no effective date stated in the transmittal (the trigger code list is marked revised 07/01/2025).
02Billing team: bill one encounter per recipient per day for each of somatic, mental health, substance use disorder and dental services; list every service performed on the claim, put the trigger code on the line at the organization's cost-per-visit rate, and list all other services at $0.00 in charge entry.
03MCO members: bill somatic services to the MCO using a code from the Encounter Data Trigger Code list (use T1015 if the center does not use CPT or HCPCS codes).
04Medicaid fee-for-service members: bill Maryland Medicaid directly using the FFS trigger codes; the transmittal says LARC procedures, SBIRT and collaborative care may be billed separately under the transmittals it cites.
05Medicare secondary claims to Medicaid FFS: put T1015 on the CMS-1500 and make the charged amount match the total charge on the Medicare Explanation of Benefits, because non-compliance may cause processing delays or rejections.
06Behavioral health: mental health and substance use services need pre-authorization and go to the behavioral health administrative services organization.
07The transmittal names Carelon in its text but names Optum in its trigger code notes, so confirm the correct organization with the Maryland Medicaid contact before routing these claims.
08For MCO members, primary mental health and substance use services by primary care practitioners or OB/GYNs go to the MCO.
09Dental: bill D0999 per visit to the dental administrative services organization (SKYGEN) using the FQHC dental per-visit rate.
10Prenatal visits: use office E/M codes 99201-99215 and do not use 59425 or 59426.
11Inpatient services by FQHC providers: bill under the rendering provider's HCPCS or CPT code with the physician's individual or group NPI and Maryland Medicaid number, never the FQHC or RHC number.
12Questions about dental billing: Earl Tucker at earl.tucker@maryland.gov.
Codes mentioned
T1015920029200492012920149920199205992119921599241992459930499318993249932899334993409934199350993819938799391993971004069990364159780297804G0108G0109119751197611981119821198359430907919083290836H0001H0004H0015H0016H0020H0047D09995942559426
Original notice
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 66-26: Federally Qualified Health Center and Rural Health Center Coding GuidelinesHighEffective Mar 3, 2026 · CodingPT 88-25: Primary Care Investment: E&M IncreasesHighEffective Aug 1, 2025 · Managed CareProposed HealthChoice AmendmentsMediumEffective Jan 1, 2003 · Managed Care OrganizationsGeneral Provider TransmittalMediumNo effective date · General ProviderBrowse every Maryland Medicaid change in the policy list
Related policy hubs
Maryland Medicaid policiesMD policy changesFamily MedicineGeneral PracticePediatricsOB-GYNPsychiatryDentistryCode T1015Code 92002Code 92004Code 92012Code 92014Code 99201Code 99205Code 99211Code 99215Code 99241Code 99245Code 99304Code 99318Code 99324Code 99328Code 99334Code 99340Code 99341Code 99350Code 99381Code 99387Code 99391Code 99397Code 10040Code 69990Code 36415Code 97802Code 97804Code G0108Code G0109Code 11975Code 11976Code 11981Code 11982Code 11983Code 59430Code 90791Code 90832Code 90836Code H0001Code H0004Code H0015Code H0016Code H0020Code H0047Code D0999Code 59425Code 59426