Updated for 2026. Medicare billing for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) has changed significantly. CMS has moved away from several bundled HCPCS reporting pathways and toward individual CPT and HCPCS codes that identify the actual care-management and care-coordination services furnished.
For billing teams, this means 2026 is not simply a code-replacement year. RHCs and FQHCs need to review care-management workflows, charge masters, EHR configurations, documentation, staff training, and claim logic.
2026 RHC and FQHC Changes at a Glance
Area2026 ChangeG0511Terminated; use applicable individual care-management codesG0512No longer reportable beginning January 1, 2026G0071No longer reportable beginning January 1, 2026Care CoordinationApplicable PFS services designated as care-management services may be separately paid as RHC/FQHC care-coordination servicesAPCM Behavioral HealthNew optional add-on codes G0568, G0569 and G0570Direct SupervisionReal-time audio/video telecommunications can satisfy applicable direct-supervision requirements
1. G0511 Is Terminated
One of the most important changes is the end of HCPCS G0511 as the general care-management billing pathway for RHCs and FQHCs.
CMS began transitioning RHCs and FQHCs to individual CPT and HCPCS care-coordination codes in 2025. After the transition period, organizations were required to use the individual codes describing the actual services furnished.
CMS's current RHC/FQHC guidance identifies G0511 as terminated.
What Should Be Used Instead of G0511?
There is no single universal replacement code.
RHCs and FQHCs should identify the actual service provided and report the applicable individual code when all requirements are met.
Depending on the patient and service, this may include:
- Chronic Care Management (CCM)
- Principal Care Management (PCM)
- Advanced Primary Care Management (APCM)
- Remote Physiologic Monitoring (RPM)
- Remote Therapeutic Monitoring (RTM)
- Transitional Care Management (TCM)
- General Behavioral Health Integration (BHI)
- Psychiatric Collaborative Care Model (CoCM)
- Chronic Pain Management
- Community Health Integration (CHI)
- Principal Illness Navigation (PIN)
- Principal Illness Navigation Peer Support
- Other designated Medicare care-management services
2. CMS Expanded the Care-Coordination Payment Framework
Effective in 2026, CMS pays qualifying services that are established under the Medicare Physician Fee Schedule and designated as care-management services as care-coordination services for purposes of separate RHC and FQHC payment.
CMS publishes a designated care-management services table annually with the Physician Fee Schedule materials.
This means billing teams should not rely on a permanently fixed internal list. The CMS designated-care-management table should be reviewed when Medicare updates the Physician Fee Schedule.
3. Care-Coordination Services Are Paid Separately
CMS states that qualifying RHC and FQHC care-coordination services may receive separate payment rather than being treated only as part of the standard RHC All-Inclusive Rate or FQHC Prospective Payment System payment.
For 2026, CMS generally uses the applicable national non-facility Physician Fee Schedule rate for qualifying designated care-management services.
Billing teams should verify the current CMS payment file and Medicare Administrative Contractor instructions before calculating expected reimbursement.
4. Revenue Code 052X Remains Important
CMS claims-processing guidance identifies revenue code 052X for RHC and FQHC care-coordination services.
The exact claim structure depends on whether the provider is an RHC or FQHC and the service being reported.
Billing systems should therefore be reviewed to make sure:
- The correct individual CPT or HCPCS code is reported
- The correct revenue code is used
- Modifiers are applied only when required
- RHC and FQHC claim-type differences are respected
- Current Medicare Administrative Contractor guidance is followed
5. G0512 Is No Longer Reportable
Beginning January 1, 2026, CMS no longer allows RHCs and FQHCs to report HCPCS G0512 as the bundled Psychiatric Collaborative Care Model code.
Instead, organizations report the applicable individual psychiatric CoCM codes when the requirements are met.
CMS materials identify individual codes such as:
- 99492
- 99493
- 99494
- G2214 when applicable
Practices should verify the current service requirements for each code rather than simply replacing G0512 with one default code.
6. G0071 Is No Longer Reportable
CMS also discontinued HCPCS G0071 beginning January 1, 2026.
G0071 previously represented certain communication technology-based and remote-evaluation services for RHCs and FQHCs.
RHCs and FQHCs now report applicable individual codes describing the actual communication or remote-evaluation service.
CMS materials identify individual codes such as G2010, G2250 and 98016 in applicable circumstances.
The correct code depends on the service furnished and current Medicare rules.
7. New APCM Behavioral Health Add-On Codes
CMS introduced optional behavioral-health add-on codes for organizations furnishing Advanced Primary Care Management.
The new 2026 HCPCS codes are:
CodeGeneral PurposeG0568Initial psychiatric Collaborative Care Model service with APCMG0569Subsequent psychiatric Collaborative Care Model service with APCMG0570General Behavioral Health Integration with APCM
These are optional add-on codes and require an applicable APCM base service furnished by the same practitioner in the same month.
The APCM base codes are:
- G0556
- G0557
- G0558
8. Advanced Primary Care Management Remains Important for RHCs and FQHCs
APCM provides a monthly primary-care management framework that incorporates multiple care-management and communication elements into a bundled service.
For organizations with an advanced primary-care model, APCM may provide an alternative workflow to separately tracking every traditional care-management service.
However, APCM is not automatically the appropriate choice for every patient or organization.
Before implementing APCM, practices should evaluate:
- Patient eligibility
- Practice capabilities
- Service-element requirements
- Consent
- Care-team workflows
- Electronic communication capabilities
- Behavioral-health integration
- Potential overlap with separately billed services
9. CCM Billing for RHCs and FQHCs
RHCs and FQHCs can report applicable individual Chronic Care Management codes when the service requirements are met.
Common CCM codes include:
CodeService99490First 20 minutes of qualifying clinical-staff CCM99439Additional clinical-staff CCM time99491CCM personally provided by physician or qualified healthcare professional99437Additional practitioner CCM time99487Complex CCM99489Additional complex CCM time
Each code has its own eligibility, time, staffing, supervision and documentation requirements.
10. PCM Billing for RHCs and FQHCs
Principal Care Management may be relevant for Medicare patients whose care-management needs center on one complex, high-risk chronic condition.
PCM codes include:
- 99424 — first 30 minutes of practitioner PCM
- 99425 — additional practitioner PCM time
- 99426 — first 30 minutes of clinical-staff PCM
- 99427 — additional clinical-staff PCM time
PCM should not be treated as a substitute for CCM simply because the code structure is different. Patient eligibility and the type of care being delivered should drive program selection.
11. RPM and RTM Are Part of the Broader Care-Coordination Framework
CMS includes Remote Physiologic Monitoring and Remote Therapeutic Monitoring among care-coordination services applicable to RHCs and FQHCs when requirements are met.
For RPM in 2026, practices should also be aware of newer options such as:
- CPT 99445 for shorter qualifying device-monitoring periods
- CPT 99470 for shorter qualifying RPM treatment-management time
Remote monitoring has separate device, data, time, medical-necessity, patient-consent and documentation requirements. A patient being enrolled in CCM or another care-management service does not automatically establish RPM eligibility.
12. Direct Supervision Can Use Real-Time Audio and Video
CMS finalized a permanent policy allowing applicable RHC and FQHC direct supervision to be furnished through real-time audio and visual interactive telecommunications.
Audio-only communication does not satisfy this particular definition of virtual direct supervision.
This change can provide additional flexibility for organizations managing distributed clinical teams, but practices must still satisfy all other applicable supervision requirements.
13. Do Not Automatically Double-Bill Overlapping Services
The availability of additional care-management codes does not mean every program can automatically be billed together.
Before reporting multiple services for the same patient, review:
- Whether each service independently meets its requirements
- Whether CMS allows concurrent reporting
- Whether the same staff time is being counted twice
- Whether the services address different activities or conditions when required
- Whether payer-specific edits apply
A strong system should allow billing staff to identify overlapping program enrollment before claims are submitted.
14. Coinsurance and Deductible Rules Still Matter
Patient financial responsibility differs depending on the provider type and service.
CMS guidance states that coinsurance and deductibles apply as applicable to RHC claims, while coinsurance applies as applicable to FQHC care-coordination claims.
Practices should explain possible patient cost sharing during consent and enrollment when required rather than describing care-management programs as universally free.
15. Example: RHC CCM Workflow in 2026
Consider an RHC managing a Medicare patient with diabetes, hypertension and COPD.
The practice determines that the patient meets CCM requirements, obtains consent, maintains a comprehensive care plan and documents 24 minutes of qualifying clinical-staff CCM activity during the month.
Instead of using the old G0511 pathway, the billing team evaluates the applicable individual CCM code supported by the documented service.
The claim is then prepared using the current RHC care-coordination billing instructions, revenue-code requirements and applicable payment rules.
16. Example: FQHC Using APCM With Behavioral Health
An FQHC provides qualifying APCM services to a Medicare patient and also furnishes appropriate general Behavioral Health Integration during the same month.
If all current CMS requirements are satisfied, the FQHC may evaluate the applicable APCM base code along with G0570 as an optional behavioral-health add-on service.
The record should separately support the APCM service and the behavioral-health integration components.
17. Update Your Billing System
One of the biggest operational risks is continuing to use outdated configuration after Medicare changes take effect.
Review:
- EHR favorites
- Charge masters
- Billing templates
- Claim-scrubbing rules
- Revenue-code mappings
- Internal fee schedules
- Old G0511 workflows
- Old G0512 workflows
- Old G0071 workflows
- APCM code mappings
- RPM and RTM codes
- Staff training material
18. Update Documentation Templates
Moving from bundled codes to individual codes means documentation needs to identify the actual service furnished.
For every program, your documentation should make it possible to determine:
- Why the patient qualifies
- Which service was delivered
- Who performed the service
- When it occurred
- How much qualifying time was spent when applicable
- What care-plan or clinical issue was addressed
- How the service relates to the CPT or HCPCS code billed
19. 2026 RHC/FQHC Billing Checklist
- Remove G0511 from active workflows where appropriate.
- Remove G0512 from 2026 claim workflows.
- Remove G0071 from 2026 claim workflows.
- Map legacy services to current individual CPT/HCPCS codes.
- Review CMS's current Designated Care Management Services table.
- Verify revenue-code 052X requirements.
- Confirm RHC versus FQHC claim differences.
- Review national non-facility PFS payment rates.
- Review APCM eligibility and service requirements.
- Add G0568, G0569 and G0570 when applicable.
- Review CCM, PCM, RPM and RTM workflows.
- Prevent duplicate time reporting.
- Update patient-consent workflows.
- Update documentation templates.
- Update billing-system code mappings.
- Train clinical and revenue-cycle staff.
- Check current MAC instructions before claim submission.
20. Telehealth Is Changing Too
RHCs and FQHCs should also review the latest CMS telehealth instructions separately from care-management billing.
CMS's current 2026 RHC/FQHC announcement states that beginning October 1, 2026, RHCs and FQHCs bill qualifying distant-site telehealth services using the individual CPT or HCPCS code describing the service along with the appropriate telehealth modifier rather than relying on the single G2025 reporting pathway.
Because telehealth policy has changed multiple times, practices should verify the latest CMS instructions and effective dates before updating claim logic.
How ChronicSync Can Help
The move toward individual care-management codes increases the need for clear separation between programs, patient eligibility, staff activity, care plans, monitoring, and monthly billing documentation.
ChronicSync helps care teams organize chronic care and remote-monitoring workflows, maintain structured patient documentation, track ongoing activities, and improve visibility across programs such as CCM, RPM, PCM and other longitudinal care services.
A structured system can help practices understand which services were actually furnished before claims reach the billing team.
Start your ChronicSync Free Pilot and explore a more organized approach to chronic care and remote-monitoring operations.
Frequently Asked Questions
Can RHCs and FQHCs still bill G0511 in 2026?
CMS identifies G0511 as terminated. RHCs and FQHCs should use the applicable individual CPT and HCPCS codes for qualifying care-management services.
What replaced G0511?
There is no single replacement. RHCs and FQHCs report the individual code describing the care-management service actually provided.
Can RHCs and FQHCs bill G0512 in 2026?
No. CMS states that G0512 is no longer reportable beginning January 1, 2026. Applicable individual psychiatric Collaborative Care Model codes should be evaluated instead.
Can RHCs and FQHCs bill G0071 in 2026?
No. CMS states that G0071 is no longer reportable beginning January 1, 2026. Applicable individual communication technology-based or remote-evaluation codes are used instead.
Can RHCs and FQHCs bill CCM?
Yes. Qualifying individual CCM codes can be reported when the patient, service, documentation, staffing, time and other Medicare requirements are satisfied.
Can an FQHC or RHC bill RPM?
CMS includes RPM among applicable care-coordination services. The individual RPM service must independently satisfy its Medicare requirements.
What are the new APCM behavioral-health codes?
The optional 2026 APCM behavioral-health add-on codes are G0568, G0569 and G0570.
How are RHC and FQHC care-coordination services paid in 2026?
CMS states that qualifying services established under the Physician Fee Schedule and designated as care-management services are paid as separate care-coordination services, generally using the applicable national non-facility PFS rate.
Sources
- CMS: FQHC/RHC News & Announcements
- CMS: CY 2026 Medicare Physician Fee Schedule Final Rule
- CMS: Medicare Claims Processing Manual Update
- CMS: Medicare Benefit Policy Manual Update
This article is provided for educational purposes only and does not constitute medical, legal, coding, reimbursement, compliance, or billing advice. Medicare policies, payment rates, code sets and implementation dates can change. Verify current CMS, Medicare Administrative Contractor, CPT/HCPCS, and payer requirements before submitting claims.