DHS Releases MA Bulletin for Vision Services Provided by FQHCs/RHCs

The Pennsylvania Department of Human Services (DHS) released a Medical Assistance Bulletin implementing a separate PPS encounter rate for vision services provided by FQHCs and RHCs. The separate vision PPS rate can be billed by an ophthalmologist or optometrist and is effective with dates of service on and after Oct. 1, 2020. DHS indicates:

  • FQHCs and RHCs may bill for a vision encounter in addition to a physical health, behavioral health and dental encounter on the same day
  • To receive a separate vision PPS encounter rate and be eligible to bill for vision encounters, FQHCs and RHCs must submit a Medicaid FQHC Cost Report to DHS
  • For billing, the U3 pricing modifier with the T1015 code must be on the claim

For more details, access the Bulletin here.