Last Updated on July 20, 2026

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,  under Medicare’s Prospective Payment System (PPS), 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 2026, explaining what they mean and when to use them, all in clear, straightforward terms.

FQHC Billing Requirements – How the PPS Model Affects CPT Code Selection

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.

Key Difference – CPT codes, maintained by the American Medical Association, standardize descriptions of medical services.  Under FQHC PPS, most visit-based CPT codes contribute to a bundled payment rate rather than generating individual fee-for-service reimbursement. However, certain codes, care management, remote monitoring, and behavioral health services, may be separately billable outside the PPS bundle. 

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.

Always verify which codes your specific FQHC PPS arrangement reimburses separately before billing. 

Core FQHC CPT Codes Every Biller Must 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.

99202 – 99205: New patient office visits

These codes are used when a patient is being seen for the first time in a practice. They require a more detailed history, examination, and medical decision making because the provider has no prior records. The complexity and time increase as the code number rises, with 99205 representing the highest level of service. Accurate selection ensures proper reimbursement and compliance.

99211–99215: Established Patient Office Visits

These codes apply when the patient has been seen before and the provider already has a medical history on file. Documentation focuses on ongoing care, follow‑up, or management of existing conditions. The level of service ranges from minimal (99211) to highly complex (99215). Correct coding prevents denials and reflects the actual work performed during the visit.

FQHC Care Management Billing Codes: CCM, APCM, and G0511 Replacement in 2026 

Beyond routine visit coding, FQHCs manage some of the most complex chronic care populations in the US. The care coordination codes below capture that additional work and represent some of the most underutilized billing opportunities in FQHC revenue cycles.  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

Covers the first 20 minutes of clinical staff time per calendar month. Covers care planning, medication reconciliation, and coordination for patients with two or more chronic conditions expected to last at least 12 months. Requires written care plan, patient consent, and electronic care management capability in the FQHC setting. 

99487 – Complex Chronic Care Management

Covers the first 60 minutes of clinical staff time per calendar month. Used for patients requiring comprehensive care plan revision, complex medication management, or coordination involving multiple specialties or facilities. Requires moderate or high complexity medical decision-making documented by the billing practitioner.

99491 – Physician-Led Chronic Care Management

First 30 minutes personally performed by a physician or qualified health professional per calendar month. Unlike 99490, this code requires the physician or QHP to personally deliver the care management service, not delegate to clinical staff. Document time and specific care management activities performed.

G0511 – Previously used for care management, is being phased out in favor of these individual CPT codes starting in 2025. 

Following its retirement, CMS expanded the use of individual care management CPT codes and Advanced Primary Care Management (APCM) codes, allowing FQHCs to report services with greater specificity.

Practices still relying on G0511 workflows may be missing reimbursement opportunities available through CCM and APCM services.

FQHC HCPCS Codes – Care Management, Telehealth, and Advanced Primary Care 

CPT codes describe physician-delivered services, but FQHC billing extends beyond patient encounters. HCPCS Level II codes support care management, telehealth, behavioral health integration, and advanced primary care services that don’t have a corresponding CPT code. .  

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 – Psychiatric Collaborative Care Model (CoCM)

Monthly payment for integrated behavioral health services involving:

• Treating physician
• Behavioral health care manager
• Psychiatric consultant

Requires registry tracking, psychiatric consultation, and care manager documentation.

Advanced Primary Care Management (APCM)

For more involved care planning and management, these HCPCS codes help document advanced services beyond standard visits.

G0556 – Advanced Primary Care Management Level 1

Covers foundational advanced primary care management services including care planning, medication management oversight, and patient coordination activities.

G0557 – Advanced Primary Care Management Level 2

Used for patients requiring more extensive care coordination, behavioral health integration, and specialist collaboration.

G0558 – Advanced Primary Care Management Level 3

Designed for high-risk patients requiring intensive management, multiple specialists, and complex social determinant interventions.

APCM services represent a growing reimbursement opportunity for FQHCs managing medically and socially complex populations.

FQHC Telehealth Billing Codes – 2026 Extension Rules and What Still Applies

Telehealth deserves its own treatment in FQHC billing, not because it uses a different code set, but because Medicare’s FQHC PPS handles telehealth reimbursement differently from standard fee-for-service billing in ways that produce systematic errors when coders apply general telehealth rules without FQHC-specific context.

Since the COVID-19 pandemic, telehealth visits in FQHCs have increased by over 50%, making correct telehealth coding more critical than ever.

Major Update: The COVID-19 PHE telehealth flexibilities were extended through December 31, 2026 under the Telehealth Extension and Evaluation Act. This is the most important telehealth update for FQHCs. The 2026 extension means FQHCs can continue billing telehealth services under expanded originating site flexibilities through year-end 2026.

Telehealth is important for FQHCs, but Medicare handles it differently here. Most standard telehealth CPT codes (like 99202–99215 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 (updated 2026 payment rate). Billed when an FQHC serves as the originating site for a telehealth encounter under Medicare. Updated payment rate effective 2026 under the FQHC PPS telehealth rules. Confirm current originating site eligibility under the 2026 PHE extension before billing. 

G2010 – Remote evaluation of recorded video or images submitted by an established patient. Used when clinical staff or a physician reviews patient-submitted images or video asynchronously and provides a follow-up response within 24 business hours. Must be initiated by the patient and not related to a previous E/M service within 7 days. 

G2012 – Virtual check-ins, brief communication between established patient and practitioner by telephone or other telecommunications device. Covers 5–10 minute medically necessary virtual consultations not originating from a previous E/M service. Patients must verbally consent and the service must be documented in the medical record with time and clinical content. 

New in 2026: CMS clarified audio-only telehand billing rules specifically for FQHC settings in the 2026 FQHC PPS update. Audio-only visits may now be billable under expanded originating site flexibilities.

Medicaid and commercial payers may accept more telehealth codes, so always check payer-specific guidelines.

Telehealth PHE extension runs through December 31, 2026. Standard E/M telehealth codes aren’t separately reimbursed under FQHC PPS, use HCPCS codes G2025, G2010, G2012 instead.

Important 2026 Updates: New CPT Codes for FQHCs

Several of the most significant FQHC billing changes in 2026 sit in categories that many practices are either underbilling or billing incorrectly such as remote monitoring, advanced care management, and behavioral health integration. Here’s what changed and what it means for your revenue cycle.

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.

Remote Physiologic Monitoring (RPM)

99091 – Remote Physiologic Monitoring, collection and interpretation of physiologic data requiring at least 30 minutes of physician or QHP time per 30-day period. Covers review and interpretation of remotely collected data  such as  blood pressure, glucose, weight, and requires a minimum 30-day monitoring period before billing.

99453 – Remote Physiologic Monitoring, setup and patient education on equipment use. One-time code covering initial setup of RPM device and education of the patient or caregiver on proper use and data transmission. Cannot be billed monthly and report only once per RPM episode of care per device type.

99454 – Remote Physiologic Monitoring, device supply with daily recording and programmed alert transmissions per 30 days. Covers the supply of monitoring equipment and transmission of patient data over a 30-day period. Requires at least 16 days of data collected and transmitted within the 30-day billing period.

99457 – Remote Physiologic Monitoring treatment management, first 20 minutes per calendar month. Covers physician or QHP time managing RPM data, reviewing trends, communicating with the patient, and adjusting the care plan based on remotely collected physiologic data. Interactive communication with the patient is required at least once per billing period.

2026 RPM Update 

RPM codes (99453, 99454, 99457, 99458) were updated in the 2026 Physician Fee Schedule. 99474 is NOT an RPM code, it is a blood pressure self-measurement code. Do not use 99474 for RPM billing.

Remote Therapeutic Monitoring (RTM)

98975 – Remote Therapeutic Monitoring, initial setup and patient education. One-time code for RTM device setup and education, covers respiratory system, musculoskeletal system, or therapy adherence monitoring. Distinct from RPM, RTM monitors non-physiologic data including therapy adherence and response rather than physiologic measurements.

98980 – Remote Therapeutic Monitoring treatment management, first 20 minutes per calendar month. Covers physician or QHP time reviewing RTM data, communicating with the patient, and adjusting therapeutic management. Requires at least 16 days of RTM data within the calendar month and documented interactive communication with the patient.

2026 RTM Update 

Medicaid coverage for RTM in FQHCs expanded in several states in 2025–2026. Confirm your state’s Medicaid policy before billing RTM codes.

Psychiatric Collaborative Care Model (CoCM)

99492 – Psychiatric Collaborative Care Model initial month. Covers the first calendar month of CoCM services for a new patient entering the collaborative care program. Requires initial assessment, registry entry, behavioral health care manager activities, and initial psychiatric consultant contact. Documentation must reflect all three team members’ involvement.

99493 – Psychiatric Collaborative Care Model, subsequent months. Used for ongoing monthly CoCM services after the initial month. Requires continued registry tracking, care manager contact with the patient, systematic treatment-to-target assessment, and ongoing psychiatric consultant involvement. Document care manager time and psychiatric consultant involvement each month.

99494 – Psychiatric Collaborative Care Model, add-on code for additional time. Billable for additional CoCM time beyond the initial or subsequent month codes. Missing from many billing guides but essential for accurate CoCM billing.

2026 CoCM Update

G0512 remains active in 2026 but CMS issued new documentation requirements for CoCM services in the 2026 Final Rule, minimum registry requirements and care manager documentation standards updated.

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.

Turn Coding Accuracy Into Stronger FQHC Financial Performance 

FQHC billing continues to evolve as CMS expands telehealth access, advanced care management programs, behavioral health integration, and remote monitoring services. Success in 2026 requires more than knowing CPT and HCPCS codes, it requires understanding how those codes interact with the FQHC Prospective Payment System, documentation requirements, and payer-specific reimbursement rules.

AnnexMed helps Federally Qualified Health Centers strengthen coding accuracy, improve compliance, reduce denials, and optimize reimbursement across E/M services, CCM, APCM, telehealth, RPM, RTM, and behavioral health programs. With the right coding strategy and operational support, FQHCs can focus on expanding access to care while protecting financial performance.

FAQs

1. What CPT codes are used for FQHC billing?

FQHC billing commonly uses E/M codes (99202–99215), CCM codes (99490, 99487, 99491), remote monitoring codes, and behavioral health integration codes alongside HCPCS codes specific to FQHC services.

2. What replaced G0511 for FQHC care management in 2026?

G0511 was retired and replaced by individual CCM, APCM, and behavioral health management codes that allow more specific reporting and reimbursement.

3. How does the FQHC Prospective Payment System affect CPT code selection?

Under PPS, most services contribute to a bundled payment rather than generating individual reimbursement, but accurate coding remains essential for compliance and quality reporting.

4. What documentation is required for CCM billing?

Patient consent, a comprehensive care plan, monthly care management time, and documented coordination activities are required.

5. Can FQHCs bill for RPM services?

Yes. RPM services may be reported using CPT 99453, 99454, 99457, and 99458 when all CMS requirements are met.

6. What is the Psychiatric Collaborative Care Model (CoCM)?

CoCM is a team-based behavioral health model involving a treating physician, behavioral health care manager, and psychiatric consultant, billed through CPT 99492–99494 or HCPCS G0512.