PE for COVID-19 Billing Instructions for FQHCs/RHCs/IHS-MOAs

April 30, 2020

On April 8, 2020, the Department of Health Care Services (DHCS) implemented a Presumptive Eligibility (PE) program for uninsured populations. This new program will allow individuals to seek necessary diagnostic testing, testing-related, and/or treatment services, including all medically necessary care related to the coronavirus disease (COVID-19), at the associated office, clinic, or emergency room visit at no cost to individuals. Aid code V2 is used for this new covered population.

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOAs) must use ICD-10-CM diagnosis code U07.1 on all claims (in Box 66) for reimbursement of COVID-19 medically necessary care for PE individuals in aid code V2.

All services billed by FQHCs/RHCs/IHS-MOAs for this program must meet the criteria of a face-to-face visit and be provided by a billable provider. FQHCs/RHCs/IHS-MOAs should submit claims using the applicable code set, including revenue code, procedure code and modifier (if required) as noted in the Medi-Cal Clinics and Hospitals provider manual. These claims will be reimbursed at the prospective payment system or all-inclusive rates. For instructions on how to bill for COVID-19 services delivered by telehealth or telephonic communication, refer to the Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19) March 24, 2020 Guidance.