Federally Qualified Health Center (FQHC) Rate Schedule

Note: Benefit Transition Date no sooner than April 1, 2025

The following information will help Medicaid Managed Care Plans identify which SBHCs are FQHCs. The link below allows you to identify those Article 28 facilities that are FQHCs. Article 28 facilities should inform each Medicaid Managed Care Plan of the locator code assigned to each SBHC that participates in the Prospective Payment System reimbursement so that the correct rate is utilized for payment.

The FQHC SBHC rate codes are as follows:

• Rate Code 4014 – FQHC Group Psychotherapy (SBHC)
• Rate Code 4015 – FQHC Off–Site Services (INDV) (SBHC)
• Rate Code 4016 – FQHC Individual Threshold Visit (SBHC)

https://www.health.ny.gov/health_care/medicaid/rates/fqhc/fqhc_rates.htm