October 27, 2026: Attention FQHC, RHC, and THC Providers: As a reminder, clinics billing for Community Health Worker (CHW) services provided within the facilities are reminded that eligible CHW services are reimbursed outside of the Prospective Payment System (PPS) methodology or All-Inclusive Rate (AIR) methodology. CHW services will be reimbursed at the fee screen rate Clinic Institutional Billing.
The CHW providing the service must be reported on the claim as the rendering provider (NPI). If the claim is billed with no rendering NPI this may cause the claim to be denied. Refer to policy bulletin MMP 23-74 for complete details.