FQHC Behavioral Health PPS and a Per-Encounter Operating Model | Legara
Per-encounter and PPS

The FQHC already bills behavioral health by the visit. The operating model around that visit is the gap.

FQHCs already bill behavioral health as a visit. CMS lists G0469 for a new FQHC behavioral health visit and G0470 for an established visit. For the published lists, see the NACHC Payment Guide and the CMS FQHC PPS page. Locality PPS dollar rates and platform fees are not published here.

The health center bills under its own NPI. Clinical authority, privileging, and the claim stay with you. The platform is built so the operating unit (a completed visit, with dedicated PSRs at 4:1) can match the unit you already bill.

Nine California health centers run that structure today. A therapist hire model (LCSW/LMFT) sits near $229K true annual cost; that $229K is a model, not every center's actuals. Average total encounter revenue to the FQHC is about $230 (PPS plus copays plus secondaries). That $230 is revenue to the FQHC, not a Legara rate. Both figures are about cash generated to serve the mission.

California operations

Nine California FQHCs. Same operating facts.

Nine active FQHC partners across California. 50,000+ encounters/year (about 950/week). 82% utilization. Under 3% provider turnover. Dedicated Patient Service Representatives at 4:1. Psychiatry wait baseline 15-20 weeks. 14% no-show rate.

Our working relationship with Legara is overwhelmingly positive. The values and professionalism of Legara's staff, providers, and leadership are aligned with our corporate culture and expectations. Legara allows us to increase access to care while improving outcomes for our patients.
Kevin Mattson
CEO, San Ysidro Health
When our psychiatry encounter volume dipped, we had zero salary burden for unused capacity. When we needed additional on-site support, Legara worked with us to find a solution that fit our operations. That is not a typical vendor response. That is a partner who does whatever it takes to make it work for our patients.
Laura Baynard
COO, Shasta Community Health Center
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The comparison is an operational walkthrough. Schedule a conversation when you want finance at the table.

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