Definition of Visit

Encounters are face-to-face contacts between a patient and a health professional for medically necessary services. A patient may have one physical health encounter and one behavioral health (psychologist or clinical social worker) encounter on the same day. If the patient later suffers an illness or injury requiring additional diagnosis or treatment on the same date of service, a separate encounter may be billed.

Dental services are limited to one dental encounter per date of service. A patient can have one dental encounter in addition to one physical health and/or behavioral health encounter on the same day.

Encounters are classified as billable or non-billable.

Billable encounters are visits for face-to-face contact between a patient and a health professional in order to receive medically necessary services such as lab services, x-ray services (including ultrasound and EKG), dental services, medical services, EPSDT services, family planning services, and prenatal services. Billable encounters are forwarded to Medicaid’s fiscal agent for payment through the proper filing of claims forms. Billable services must be designated by procedure codes from the Physicians Current Procedure Terminology (CPT) or by special procedure codes designated by Medicaid for its own use.

Non-billable encounters are visits for face-to-face contact between a patient and health professional for services other than those listed above (i.e., visits to social worker, LPN). Such services include, but are not limited to, weight check only or blood pressure check only. Non-billable encounters cannot be forwarded to Medicaid’s fiscal agent for payment.

SOURCE: AL Medicaid, Ch. 15 Alabama FQHC Manual, Jan. 2024, p. 7, (Accessed Feb. 2024).

Encounters are face-to-face contacts between a patient and a health professional for the provision of medically necessary services.

• Ancillary Encounter – Face-to-face contact between a patient and a health professional for lab or x-ray services only.
• Dental Encounter – Face-to-face contact between a patient and a health professional for the provision of dental services.
• Medical Encounter – Face-to-face contact between a patient and a health professional for the provision of medical services (i.e., physician, physician assistant, nurse practitioner).
• EPSDT, Family Planning, or Prenatal Encounter – Face-to-face contact to receive services within the parameters of the program guidelines.

 SOURCE: Ala. Admin. Code r. 560-X-56-.03, (Accessed Feb. 2024).