Reason Code: W7089

Error Description:

FQHC PPS(77X TOB) claim contains one of the specific payment codes (G0466-G0470); however, a HCPCS code for the qualifying visit is not reported on the same day.

Avoiding/Correcting This Error

Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying visit. 

Verify billing. If appropriate, correct and resubmit the claim.

Related Content

• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 60.2 - Billing for FQHC Claims Paid under the PPS
• CMS list of qualifying visits for each payment specific code