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

Originally published April 30, 2020
Updated on April 16, 2021

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.

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.