Section 17b-262-999 - Billable services(a) Billable services for FQHCs shall include core and noncore services identified in section 17b-262-997 of the Regulations of Connecticut State Agencies.(b) Covered core and noncore services shall be billed on an encounter basis in accordance with section 17b-262-1002 and are subject to the following limitations:(1) Billable encounters shall include encounters that: (A) Take place at a service site approved by HRSA as part of a FQHC; or(B) Take place in a patient's home for the purpose of providing services to FQHC patients; and(C) Are documented in the patient health records.(2) The services of a registered nurse may be billed as a medical encounter unless provided incident to a medical encounter as described in subsection (b)(3) of this section.(3) Encounters with more than one health professional for the same type of service (e.g., a nurse and a physician provide a medical encounter) and multiple interactions with the same health professional that take place on the same day constitute a single encounter except when the patient, after the first interaction, suffers illness or injury requiring additional diagnosis and treatment.(4) Tobacco cessation counseling shall be prescribed by a physician, physician's assistant, dentist or APRN and may be billed as a medical encounter, behavioral health encounter or dental encounter depending upon the type of health professional or allied health professional providing the service. The following health professionals may provide tobacco cessation counseling:(B) Physician assistants;(E) Clinical Psychologists;(G) Allied health professionals.(5) Group sessions prescribed by a health professional shall be billed as an encounter subject to the following limitations:(A) All group sessions shall be limited to a maximum of twelve participants, shall be facilitated by a health professional or allied health professional practicing within his or her scope of practice and shall last at least 45 minutes; and(B) The services provided in the session shall be documented in each client's health record if the FQHC bills the session as an individual encounter for each participant.(6) Consultations with anyone other than the patient are not considered encounters, and are therefore not billable.(c) The following services shall be included in the encounter rate and the FQHC shall not bill separately for these services:(1) Services and supplies incidental to the services of a health professional or allied health professional when the services and supplies are: (A) Of the type commonly furnished in a physician's office;(B) Of a type commonly rendered either without charge or included in the FQHC's bill;(C) Furnished as an incidental, although integral, part of the professional service; and(D) Provided by FQHC employees under the direct supervision of a physician, clinical psychologist or licensed clinical social worker;(2) Laboratory, point-of-care testing or radiology services provided in conjunction with a FQHC encounter and furnished by FQHC staff; and(3) Transportation provided by the FQHC.(d) The following services are not billable as a FQHC encounter. These services may be billed by the FQHC in accordance with the applicable Medicaid fee schedule: (1) Inpatient hospital services;(2) Delivery of a baby; and(e) The following services may be billed for by the provider of the services in accordance with the Medicaid fee schedule: (1) Laboratory services beyond point of care testing that are referred to and performed by an independent laboratory; and(2) The technical component of radiology tests that are referred to and performed by an independent radiologist.(f) A FQHC shall not seek reimbursement for services provided under subsections (c) (d) and (e) of this section as a FQHC encounter. The non-FQHC services shall not be included in the overall costs of providing services at the FQHC.Conn. Agencies Regs. § 17b-262-999