CurrentExecutive Office of Health and Human ServicesPolicy N/A

FQHC SFY 27 per-encounter rate listings

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This document lists Federally Qualified Health Center (FQHC) encounter-type specific reimbursement rates and provider identifiers effective for State Fiscal Year (SFY) 2027, and applies to the listed provider sites and encounter types for billing and payment. It affects listed FQHC providers and payers administering Executive Office of Health and Human Services payments.

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyFQHC SFY 27 per-encounter rate listings

Policy CodePolicy N/A

Change TypeRate table update (no material coverage change)

Effective Date7/1/2026

Next Review Date

Key ActionUse the listed provider-specific encounter rates for SFY 27 by encounter type (Medical, Behavioral Health, Dental) for reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

SFY 27rate year/effective period

7/1/2026effective date

multipleprovider sites listed

Medical/Behavioral/Dentalrates provided

4/17/26document update

FQHC Per-Encounter Rates (SFY 27)

Encounter Types and Coding

Billing and Provider Actions

Billing Rule

FQHC SFY 27 encounter rates — use listed per-encounter amounts effective 7/1/2026

Use the listed SFY 27 per-encounter rates (effective 7/1/2026) when billing for FQHC encounters. Rates are provided by provider site, provider NPI, provider ID, encounter type (Medical, Behavioral Health, Dental), and SFY 27 per-encounter amount — for example: Providence Community Health Center — Medical (NPI 1891775128, Provider ID 7001361) $311.41; Providence Community Health Center — Behavioral Health (NPI 1891775128, Provider ID TH92793) $311.41; Providence Community Health Center — Dental (NPI 1477545549, Provider ID PA07326) $249.52; Providence Community Health Center — Medical (NPI 1063574135, Provider ID BV01759) $319.33; Blackstone Valley Health Center — Behavioral Health (NPI 1063574135, Provider ID BL88798) $319.33; Blackstone Valley Health Center — Dental (NPI 1104046226, Provider ID BV09336) $238.95. Apply these encounter-type rates for claims with dates of service on or after 7/1/2026.

Rates effective date: 7/1/2026 (SFY 27).
Billing must use the per-encounter amount listed for the provider site and encounter type.
Rates shown cover Medical, Behavioral Health, and Dental encounter types as listed.

Key Definitions

inv-04: Encounter Type

DefinitionEncounter Type — the category of service for which the FQHC rate applies (examples in this document: Medical, Behavioral Health, Dental).

Examples in this policyMedical, Behavioral Health, Dental — each listed provider line shows the encounter type that determines which per-encounter rate applies.

UsageApply the listed SFY 27 per-encounter rate corresponding to the encounter type when billing for FQHC services at the specified provider site.

ScopeEncounter Type is used only to select the appropriate per-encounter reimbursement amount; it does not change clinical coverage or authorization requirements.

inv-05: SFY 27 Rates

Effective date7/1/2026 (SFY 27)

Per-encounter rates (examples)Providence Community Health Center — Medical/Behavioral Health: $311.41; Providence Community Health Center — Dental: $249.52; Blackstone Valley Health Center — Dental: $238.95; (rates listed per provider and encounter type in the table).

ApplicabilityRates apply to the listed FQHC provider sites and encounter types for State Fiscal Year 2027 reimbursements effective 7/1/2026.

Document updateUpdated 4/17/26 for SFY 2027

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyFQHC SFY 27 per-encounter rate listings

Policy CodePolicy N/A

Change TypeRate table update (no material coverage change)

Effective Date7/1/2026

Next Review Date

Key ActionUse the listed provider-specific encounter rates for SFY 27 by encounter type (Medical, Behavioral Health, Dental) for reimbursement.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentExecutive Office of Health and Human ServicesPolicy N/A

FQHC SFY 27 per-encounter rate listings

Customize your policy alerts

Sign up for all Executive Office of Health and Human Services policy alerts

Know when Executive Office of Health and Human Services releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyFQHC SFY 27 per-encounter rate listings

Policy CodePolicy N/A

Change TypeRate table update (no material coverage change)

Effective Date7/1/2026

Next Review Date

Key ActionUse the listed provider-specific encounter rates for SFY 27 by encounter type (Medical, Behavioral Health, Dental) for reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

SFY 27rate year/effective period

7/1/2026effective date

multipleprovider sites listed

Medical/Behavioral/Dentalrates provided

4/17/26document update

FQHC Per-Encounter Rates (SFY 27)

Encounter Types and Coding

Billing and Provider Actions

Billing Rule

FQHC SFY 27 encounter rates — use listed per-encounter amounts effective 7/1/2026

Rates effective date: 7/1/2026 (SFY 27).
Billing must use the per-encounter amount listed for the provider site and encounter type.
Rates shown cover Medical, Behavioral Health, and Dental encounter types as listed.

Key Definitions

inv-04: Encounter Type

DefinitionEncounter Type — the category of service for which the FQHC rate applies (examples in this document: Medical, Behavioral Health, Dental).

Examples in this policyMedical, Behavioral Health, Dental — each listed provider line shows the encounter type that determines which per-encounter rate applies.

UsageApply the listed SFY 27 per-encounter rate corresponding to the encounter type when billing for FQHC services at the specified provider site.

ScopeEncounter Type is used only to select the appropriate per-encounter reimbursement amount; it does not change clinical coverage or authorization requirements.

inv-05: SFY 27 Rates

Effective date7/1/2026 (SFY 27)

ApplicabilityRates apply to the listed FQHC provider sites and encounter types for State Fiscal Year 2027 reimbursements effective 7/1/2026.

Document updateUpdated 4/17/26 for SFY 2027

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyFQHC SFY 27 per-encounter rate listings

Policy CodePolicy N/A

Change TypeRate table update (no material coverage change)

Effective Date7/1/2026

Next Review Date

Key ActionUse the listed provider-specific encounter rates for SFY 27 by encounter type (Medical, Behavioral Health, Dental) for reimbursement.

SourceLink

On This Page