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MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth
Act
immediately
Effective date
Aug 1, 2025
Identified
Jun 19, 2026
Summary
Blue Cross of Idaho updated FQHC billing requirements for Medicare Advantage patients, removing MMCP/IMP billing requirements and clarifying language for Chronic Care Management (CCM), Virtual Communication Services (VCS), Psychiatric Collaborative Care Model (CoCM), and telehealth services. FQHCs must continue using specific revenue codes and HCPCS codes for qualifying services under the CMS Prospective Payment System.
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What to do
immediately · 4 steps
01FQHC billing teams must stop using MMCP/IMP billing requirements that were previously required.
02Ensure all Medicare Advantage FQHC claims continue using TOB 77X with appropriate revenue codes (0519, 0521, 0522, 0524, 0525, 0527, 0528, 0900) and corresponding HCPCS codes (G0466-G0470, G0511, G0071, G0512, G2025).
03Add FQ modifier to all telehealth claims.
04Claims without proper TOB, revenue codes, and HCPCS codes will be denied.
Codes mentioned
92002920049201292014978029780399201992029920399204992059921299213992149921599304993059930699307993089930999310993159931699318993249932599326993279932899334993359933699337993419934299343993449934599347993489934999350994069940799495994969949790791907929083290834908379083990845G0071G0101G0102G0108G0117G0118G0270G0296G0402G0438G0439G0442G0443G0444G0445G0446G0447G0466G0467G0468G0469G0470G0490G0511G0512G2025Q0091
Original notice
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth
providers.bcidaho.com · Always check the source before changing claims.
Related changes
See all Blue Cross of Idaho changes →MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive examsMediumNo effective date · ReimbursementMAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarificationMediumNo effective date · ReimbursementMAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Added language about preventive exams and revised billing instructions for care coordination, VCS, CoCM, telehealth, and vaccines per CMS coding updates.MediumNo effective date · CodingMAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions addedMediumEffective Aug 1, 2025 · ReimbursementBrowse every Blue Cross of Idaho change in the policy list
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