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FQHC/RHC/IHS-MOA Code Conversion Policy Overview

September 15, 2017

Effective for dates of service on or after October 1, 2017, Service Authorization Requests (SARs) and claims billed with HCPCS Level III local FQHC/RHC/IHS-MOA codes will no longer be eligible for reimbursement.

Providers submitting SARs with dates of service on or after October 1, 2017, must include the appropriate HIPAA-compliant billing code sets described in the following crosswalks announced in January 2017:

Providers should review their inventory for previously-approved SARs with FQHC/RHC/IHS-MOA services that have dates of services on or after October 1, 2017. For those SARs, providers must submit a new SAR with the appropriate billing code set to cover any remaining service period on or after October 1, 2017.

If a SAR is submitted for the purpose of updating codes in the same authorization period, it will not be reviewed for medical necessity.

In addition, the following Remittance Advice Details (RAD) codes are added to help reconcile provider accounts:

RAD Code Message
9269 Quantity exceeds allowed for the service.
9273 Quantity exceeds allowed for the service; medical justification required.
9274 Not payable due to another service paid on same date of service; medical justification required.
9280 Split bill claims for DOS before and after 10/01/2017.
9281 IPPE/AWV service not payable due to another IPPE/AWV service paid on same date of service.
9993 The service code combination is not valid for billing provider.

Provider Resources
Providers should refer to the FQHC/RHC/IHS-MOA section of the HIPAA: Code Conversions web page for a complete list of FQHC/RHC/IHS-MOA resources.