Estimates only. Not a quote. Not a guarantee. Not a contract. Medicare and Medicaid bundling. For Medicare patients at an FQHC, CPT 92229 is bundled into the FQHC PPS encounter rate under 42 CFR 405.2462. For Medicaid patients at an FQHC, 92229 is similarly bundled into the state Medicaid FQHC PPS rate, with statutory wraparound from the state to a PPS floor on Medicaid Managed Care payments per Social Security Act section 1902(bb). For FQHCs participating in CalAIM (CA), Oregon APCM, or Washington APM 3 / APM 4, 92229 is embedded in the per-member-per-month capitation. For Medicare and Medicaid AI/AN beneficiaries at IHS-direct and Tribal 638 facilities, 92229 is bundled into the IHS Outpatient All-Inclusive Rate (AIR) under 42 USC 1395qq and 1396d(b). Per 42 CFR 405.2463, a qualifying FQHC visit requires a face-to-face encounter with a qualifying practitioner; a standalone DR screening day without a qualifying-practitioner touch does not trigger a PPS or AIR encounter. Commercial / private insurance. Commercial reimbursement at FQHCs and Tribal facilities is NOT governed by federal PPS rules or by the IHS AIR. It is governed by individual payer contracts. Some commercial contracts mirror PPS (encounter-based); others pay fee-for-service where 92229 may be a separately payable line item. ERISA self-funded employer plans follow the underlying TPA/ASO network contract. Confirm each of your top commercial payer contracts with your billing director. Per-screen rate myth. The per-screen Medicare CY 2026 figure of $40 to $55 commonly cited for CPT 92229 applies to non-FQHC physician offices and does NOT apply to FQHC, FQHC Look-Alike, or Tribal facility economics for Medicare or Medicaid patients. Rate sources. Medicare FQHC PPS base $207.72 per CR 14309 (CY 2026). AWV / IPPE / new-patient adjusted rate $271.88. CY 2026 IHS Outpatient AIR Lower 48: $733 Medicare-side and $826 non-Medicare-side per Federal Register notice 2026-01178 (RIN 0917-AA26, 91 FR 2786). Alaska IHS sites use higher AIRs; not modeled here as the West territory excludes AK. Under state Medicaid fee-for-service (whether the program is called Medi-Cal in California, Apple Health in Washington, or another state-specific name), CPT 92229 is bundled into the facility-specific FQHC PPS encounter and is not separately payable. Under Medicaid managed care, whether 92229 is bundled into the negotiated encounter rate, separately payable as a line item, or required in a particular form to earn EED quality credit is determined by each individual Medicaid Managed Care Plan contract and is not a uniform rule. FQHCs on a state APM program (such as California's CalAIM, Oregon's APM 2B, or Washington's APM4) are paid a per-member capitation that replaces encounter billing entirely. The Medicaid rate defaults in this calculator are illustrative placeholders only and must be replaced with each FQHC's actual contracted encounter rate. APM thresholds. CalAIM, Oregon APCM, and Washington APM 4 do not use flat percentage thresholds. The actual programs use per-FQHC percentile benchmarks or year-over-year improvement targets. APM threshold values shown in this calculator are INDICATIVE planning placeholders only. Tribal value drivers. For Tribal Health Programs, the primary value of autonomous DR screening is patient care (closes the referral-completion gap for rural and reservation-based panels), GPRA reporting performance, and SDPI grant scope-of-work protection. Encounter capture at AIR is meaningful but not the primary driver. Edge cases not modeled here. Workers compensation, auto and liability claims pay on state workers comp fee schedules or the FQHC published fee schedule, outside PPS. VA Community Care Network and TRICARE pay on their respective contract terms, outside PPS. Self-pay patients at FQHCs are billed line-item from the published full fee schedule with the HRSA sliding fee discount applied, NOT at the encounter rate; net collections are typically low. Volume across these buckets is typically less than 2 to 5 percent of FQHC encounters. Verify before contracting. Actual reimbursement, P4P earn-back, APM threshold compliance, and SDPI grant outcomes depend on your specific Medicare Administrative Contractor (MAC), IHS Area Office, state Medicaid program, MCO contract, payer mix, billing accuracy, and program eligibility. Nothing in this calculator constitutes financial, legal, billing, or compliance advice. Confirm every figure with your MAC, IHS Area Office, state Medicaid program, and MCO contract administrator before relying on these numbers for budgeting, contracting, or grant submission. AEYE Health makes no representation or warranty that any value shown will be realized.