1. SMV Billing Strategies in FQHCs
Fasih Hameed, MD
Associate Medical Director, Wellness & Integrative Medicine, Petaluma Health Center
Assistant Professor of Family Medicine,
UCSF –Santa Rosa Family Medicine Residency

4. Benefits of SMA/SMV/Groups
Increased contact time with patients
Increased educational time
Social interaction for isolated pts
Group Learning
Strengthening community
Increased Access to care
Delivery of innovative care
support for goal setting and lifestyle change
The intangible

5. Billing for Groups Mental Health Professionals CPSP
Varies among insurance carriers
Generally can bill one person in each group
90853 covered and reimbursed, but no wrap for FQHC
Psychiatrist can bill SMV-style
CPSP
Bill one person in each group, unless 8 minutes of face to face time “one-on-one” time, then can bill individuals

6. Billing for Groups MD/DO/NP/PA
Group, “shared medical visit”, individual visit conducted in front of others
HIPPA disclosure and waiver
Confidentiality reviewed
Face-to-Face time documented and billed
Bill appropriate E&M ONLY for individual services

7. Billing for Groups: Medical Acupuncture
A standard office visit is conducted and documented
Appropriate HPI, PE, Assessment and Plan is documented
Bill for office visit
Acupuncture is considered a “Complementary Complementary Service”
May need scope change
MD/DO only (no NP/PA)
Acup specific CPT codes can be used as well, but may have to pay back depending on your system
In California, it is a covered benefit for PHP/mediCal

8. AAFP guidance

9. AAFP guidance
“…group visits are a proven, effective method for enhancing patient’s self-care...and improving outcomes.”

10. AAFP guidance
“...individual evaluation could take place either separately or within the group process…”
“…should code for the services provided using applicable, existing evaluation and management codes found in [CPT].”

12. The response from CMS was “…under existing CPT codes and Medicare rules, a physician could furnish a medically necessary face-to-face E/M visit (ie 99213) to a patient that is observed by other patients.”

13. From Blue Cross/Shield NC