Medicare AdvantageAdministrativeMedium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth
Blue Cross of Idaho·ID · Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
Effective date
Aug 1, 2025
We identified it
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.
Action Required
Immediately: FQHC billing teams must stop using MMCP/IMP billing requirements that were previously required. Ensure 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). Add FQ modifier to all telehealth claims. Claims without proper TOB, revenue codes, and HCPCS codes will be denied.