Recent updates to FQHC coding and billing

CMS updated an MLN Booklet on Federally Qualified Health Centers (FQHC) to reflect policy updates in the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule. The guidance now includes updated payment rates, recent Healthcare Common Procedure Coding System (HCPCS) changes, and more.

The CY 2026 intensive outpatient program payment rates are $319.38 for three or fewer services per day, and $418.45 for at least four services per day. The FQHC market basket is 2.5% for CY 2026, and the prospective payment system base payment rate is $207.72. For telehealth services, the originating site fee is $31.85.

Effective January 1, 2026, CMS added three new optional add-on HCPCS codes (G0568-G0570) that organizations are to use when providing general behavioral health integration and psychiatric collaborative care model (CoCM) services in the same month as advanced primary care management (APCM) services. Facilities must report an APCM base code (G0556-G0558) in the same month as the optional add-on codes, according to the agency.

CMS clarified that FQHCs may continue to bill for telehealth services using HCPCS code G2025. It will base the payment amount on the national average payment rates for comparable services under the MPFS through December 31, 2026. FQHCs are also authorized to serve as distant site practitioners for non-behavioral and non-mental health services through the same date.

Other revisions to the guidance include additional coding guidelines for psychiatric CoCM services, updated supervision requirements, and more. Revenue integrity professionals at FQHCs should review the booklet and CY 2026 MPFS final rule to ensure their organization is in compliance with the recent changes.