Medicare updates FQHC and RHC billing codes for care management in 2026
Starting in 2026, Medicare updates care management billing for FQHCs and RHCs with new CPT and HCPCS codes.
Why it matters: Healthcare legal and compliance professionals must adapt billing processes to meet new Medicare requirements and avoid audit issues.
- From January 1, 2026, Medicare ends bundled HCPCS code G0512 for Psychiatric Collaborative Care Model (CoCM) in FQHCs and RHCs.
- FQHCs and RHCs must bill CoCM using CPT codes 99492, 99493, 99494 plus HCPCS G2214, reimbursed under the Physician Fee Schedule.
- Beginning October 1, 2026, distant-site telehealth billing shifts from HCPCS G2025 to specific CPT/HCPCS codes for FQHCs and RHCs.
- The Consolidated Appropriations Act 2026 extends telehealth provider status for FQHCs and RHCs through January 1, 2028.
The Centers for Medicare & Medicaid Services (CMS) announced key changes to how Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will bill Medicare for care management services starting January 1, 2026. CMS will retire the bundled HCPCS code G0512, which covered Psychiatric Collaborative Care Model (CoCM) services under the existing Prospective Payment System (PPS), a method that provided standardized monthly payments averaging $145.96.
Under the new rules, FQHCs and RHCs must use specific Current Procedural Terminology (CPT) codes — 99492, 99493, and 99494 — along with the Healthcare Common Procedure Coding System (HCPCS G2214) for billing CoCM. These services will be reimbursed according to the national non-facility Physician Fee Schedule, which determines payments for providers outside hospital settings. This replaces the PPS bundled payment method, aiming to improve billing detail and payment accuracy. A Legalclarity analysis explains that these code changes offer clearer differentiation of services rendered.
Telehealth billing for FQHCs and RHCs will also change starting October 1, 2026. The previous use of HCPCS G2025 — which covered distant-site telehealth services — will be replaced by more specific CPT or HCPCS codes that precisely describe the telehealth service provided. CMS detailed this update in its MM14468 guidance, emphasizing improved claims accuracy and reduced coding ambiguity.
The Consolidated Appropriations Act of 2026 permits FQHCs and RHCs to continue acting as distant-site telehealth providers through January 1, 2028, extending flexibilities established during the COVID-19 public health emergency. This extension supports ongoing access to remote care in rural and underserved communities.
Healthcare legal commentators have noted these Medicare updates represent a significant shift in how safety-net providers receive reimbursement for care outside in-person visits. Compliance professionals should promptly review billing and coding protocols to align with the new codes and fee schedules, minimizing reimbursement risk.
By the numbers:
- $145.96 — average monthly payment under bundled HCPCS G0512 code for CoCM
- January 1, 2026 — effective date for Medicare billing changes for FQHCs and RHCs
- January 1, 2028 — extension date for distant-site telehealth provider status under Consolidated Appropriations Act 2026