Last Updated on September 12, 2025 by admin
More than 30 million patients receive care at Federally Qualified Health Centers annually!
FQHCs play an essential role in delivering healthcare services to underserved populations across the country. Because of their unique payment model, understanding the specific CPT and HCPCS codes used in FQHC billing is crucial for coders and billers.
We have outlined the most common FQHC CPT and HCPCS codes for 2025, explaining what they mean and when to use them, all in clear, straightforward terms.
FQHCs and Their Coding Requirements
FQHCs operate under the Medicare Prospective Payment System (PPS), which provides a bundled payment rate for patient visits. While this differs from the fee-for-service model, accurate CPT and HCPCS coding remains necessary to report services properly and receive additional reimbursement when applicable.
CPT codes, maintained by the American Medical Association, standardize descriptions of medical services. HCPCS codes fill in the gaps for services and supplies not covered by CPT codes, particularly in Medicare and Medicaid billing. For FQHCs, correct coding helps ensure compliance, supports quality reporting, and protects against denied claims or audits.
Key FQHC CPT Codes to Know
Getting familiar with the core CPT codes is the first step to making sure FQHC billing services run smoothly. These codes are like the building blocks of your billing process, they represent the services provided during patient visits and help translate what happens in the clinic into billable units.
Primary Care and Evaluation & Management (E/M) Codes
These codes form the backbone of most visits, covering routine patient care that happens every day in the clinic.
- 99201 – 99205: New patient office visits
- 99211 – 99215: Established patient office visits
Because of the bundled payment system, not all codes may be reimbursed individually, so it’s important to verify which codes apply under your FQHC’s specific PPS arrangement.
Care Coordination Codes
When managing patients with chronic conditions, specific codes capture the extra work that goes into coordinating their care, few important CPT Codes are:
- 99490: Chronic Care Management (CCM)
- 99487: Complex CCM for patients needing more intensive management
- 99491: CCM requiring at least 30 minutes of physician time per month
Note that G0511, previously used for care management, is being phased out in favor of these individual CPT codes starting in 2025.
HCPCS Codes: The Unsung Heroes of FQHC Billing
Think of HCPCS codes as the trusty sidekick to CPT codes, they cover a lot of ground, especially for services and supplies that don’t have a dedicated CPT code. These are some of the Important HCPCS codes for FQHC:
- G0511: The old care management code that’s getting phased out in 2025. It’s like the classic flip phone, still recognizable but ready to retire.
- G0512: The code for the Psychiatric Collaborative Care Model (CoCM), reflecting CMS’s focus on integrating mental health into primary care.
Advanced Primary Care Management (APCM)
For more involved care planning and management, these HCPCS codes help document advanced services beyond standard visits.
- G0556, G0557, G0558: Cover various levels of advanced primary care management, including care planning and coordination.
HCPCS codes also come in handy for telehealth and remote services that don’t fit neatly into the CPT codebook. So don’t overlook them; they’re a big part of the FQHC billing toolkit.
Telehealth Codes in FQHCs: The Essentials
Since the COVID-19 pandemic, telehealth visits in FQHCs increased by over 50%, making correct telehealth coding more critical than ever.
Telehealth is important for FQHCs, but Medicare handles it differently here. Most standard telehealth CPT codes (like 99201–99215 with modifier 95) aren’t separately reimbursed under Medicare’s FQHC Prospective Payment System (PPS). Instead, telehealth visits are usually included in the bundled payment.
Some HCPCS codes used for FQHC telehealth billing are:
- G2025: Telehealth originating site facility fee
- G2010: Remote evaluation of recorded video/images
- G2012: Virtual check-ins
Medicaid and commercial payers may accept more telehealth codes, so always check payer-specific guidelines.
Important 2025 Updates: New CPT Codes for FQHCs
CMS has introduced several new CPT and HCPCS codes replacing the broad G0511 care coordination code. These changes allow more precise billing for care coordination, remote monitoring, and behavioral health services.
Here are some important new codes:
- Remote Physiologic Monitoring (RPM): Codes 99091, 99453, 99454, 99457, 99474 enable billing for remote monitoring of physiological data, such as blood pressure or glucose.
- Remote Therapeutic Monitoring (RTM): Codes 98975 – 98981 cover remote monitoring of patient adherence and therapy response.
- Psychiatric Collaborative Care Model (CoCM): Codes 99492, 99493, and G0512 support billing for integrated behavioral health services, an important focus for CMS.
Between 2015 and 2022, FQHC visits grew by over 20%, reflecting increasing reliance on these centers for primary care. Keeping coding accurate and up-to-date ensures reimbursement keeps pace with this growth.
Accurate CPT and HCPCS coding not only affects reimbursement but also strengthens documentation, supports quality metrics, and facilitates care coordination. Mistakes in coding risk claim denials, audits, and ultimately, loss of revenue and resources.
Focusing on core codes for primary care visits, care coordination, advanced management, and the new remote monitoring and behavioral health services will position coders and billers for success in 2025.
