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FQHC and RHC Billing Services
A federally qualified health center is paid per visit under the FQHC prospective payment system. A rural health clinic is paid an all-inclusive rate per visit, capped for most clinics at $165 in 2026. Both bill Medicare on institutional claims, and both now bill care management with the individual CPT and HCPCS codes, because the old bundle codes are retired.
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Encounter rate
What FQHC and RHC billing includes
Encounter-based payment for visits, and separate payment for care management.
FQHC visits go on bill type 77X with one of five FQHC payment codes: G0466 for a new patient visit, G0467 for an established patient visit, G0468 for an initial preventive physical exam or annual wellness visit, G0469 for a new patient mental health visit, and G0470 for an established patient mental health visit, each followed by the qualifying CPT lines. Medicare pays 80% of the lesser of the center’s charge or the PPS rate, and the Part B deductible does not apply.
RHC visits go on bill type 71X with the qualifying CPT lines. Medicare pays 80% of the clinic’s all-inclusive rate, up to the per-visit limit: $165 for 2026 and $178 for 2027 for independent clinics and most provider-based ones. Provider-based RHCs in hospitals under 50 beds can have their own limit.
What the FQHC and RHC fee covers
- Qualifying visits on the right bill type with the right payment code
- Care management billed outside the PPS or all-inclusive rate
- Medicaid wraparound and sliding-fee balances tracked
- Mental health visits by telecommunication tracked against the in-person rule
FQHC and RHC codes that matter in 2026
The retired bundle codes are the most common reason care management goes unpaid.
| Code or rule | What it is | 2026 status |
|---|---|---|
| G0466 to G0470 | FQHC payment codes for medical, preventive, and mental health visits | In use on 77X claims |
| G0511 | Former general care management code | Not reportable since January 1, 2025. Bill the individual CCM, PCM, BHI, RPM, RTM, CHI, PIN, and APCM codes |
| G0512 | Former psychiatric collaborative care code | Not reportable from January 1, 2026. Bill 99492, 99493, 99494, or G2214 |
| G0071 | Former virtual communication code | Not reportable from January 1, 2026. Bill the individual communication technology codes, such as G2012 and G2250 |
| G0556 to G0558 | Advanced primary care management, billed monthly, not time based | Billable since 2025; optional behavioral health add-ons from 2026 |
| Mental health by telecommunication | Audio-video, or audio-only where allowed, mental health visits | Paid under the PPS or all-inclusive rate; the in-person visit requirement does not apply until at least January 1, 2028 |
| G2025 | Former single code for medical distant site telehealth | Not used for dates of service from October 1, 2026. Bill the CPT or HCPCS code for the service with modifier 95 (audio-video) or 93 (audio-only) |
| RHC per-visit limit | Cap on the all-inclusive rate | $165 in 2026, $178 in 2027 |
RPM at a health center follows the same 2026 device and time codes: remote patient monitoring billing.
Where FQHC and RHC revenue is lost
Health center money is usually lost in the bundle rules, not the visit.
Care management left in the visit
CCM, PCM, behavioral health integration, and RPM are paid separately at physician fee schedule rates, outside the encounter rate. Billing them on the visit, or with a retired G code, loses the payment.
Wrong bill type or missing payment code
An FQHC line without a G0466 to G0470 code, or an RHC claim built like a professional claim, is returned or paid at the wrong rate.
Same-day visits
Medicare pays one visit per day, with exceptions: a medical visit and a mental health visit on the same day, or an illness or injury that starts after the first visit that day.
Medicaid wraparound not reconciled
State Medicaid owes FQHCs and RHCs the difference between the managed care plan’s payment and the PPS rate. Wrap claims that are not reconciled leave money with the state.
Sliding fee balances billed in full
Health centers funded under section 330 must offer a sliding fee discount to patients at or below 200% of the federal poverty guidelines. Statements have to reflect the discount.
Practitioner not linked to the clinic
A new practitioner who is not on the clinic’s enrollment and payer rosters produces denials on every visit until the link is made.
Not inside the monthly fee
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
Medicare cost reports, Medicaid PPS rate setting, HRSA grant reporting, and UDS submissions are outside the billing engagement.
Find unpaid care management and wrap payments
Send the last three months of claims with your Medicaid plans. We report care management billed on retired codes, unreconciled wrap claims, same-day visit errors, and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
FQHC and RHC billing questions
Straight answers for health centers and rural clinics.
What codes do FQHCs use for Medicare visits?
One of five FQHC payment codes on bill type 77X: G0466 new patient, G0467 established patient, G0468 IPPE or annual wellness visit, G0469 new patient mental health, and G0470 established patient mental health, followed by the qualifying CPT lines.
What is the RHC payment limit for 2026?
$165 per visit for independent RHCs and provider-based RHCs in hospitals with 50 or more beds, rising to $178 in 2027. Some provider-based RHCs in smaller hospitals keep a limit based on their own rate.
Can FQHCs and RHCs still bill G0511?
No. Since January 1, 2025, health centers bill the individual care management codes that replaced G0511. G0512 and G0071 were retired from January 1, 2026.
Is chronic care management paid inside the FQHC rate?
No. Care management services, except transitional care management, are paid separately at physician fee schedule rates, outside the FQHC PPS and the RHC all-inclusive rate.
Can an FQHC or RHC bill two visits on the same day?
Only in specific cases: a medical visit and a mental health visit on the same day, or a new illness or injury after the first visit that day. Otherwise Medicare pays one visit per day.
How do FQHCs and RHCs bill medical telehealth after October 1, 2026?
With the individual CPT or HCPCS code for the distant site service and modifier 95 for audio-video or 93 for audio-only, instead of G2025. Medicare pays a national rate based on physician fee schedule telehealth payments, not the PPS or all-inclusive rate, through December 31, 2027. Mental health visits by telecommunication stay under the PPS and all-inclusive rate. See telehealth billing.
How is the fee set?
As a percentage of net collections (flat or per claim in New York) on the book you hand over. No setup fee on the monthly cycle, month to month, with 30 days’ written notice. The written rate follows volume, payer mix, and scope.