CMS CY2026/27 Payment and Coding Changes
Key Questions
What changes are being made to the FQHC PPS rate for CY2026?
The FQHC PPS rate increases by 2.5% to $207.72, with a separate APCM payment available. G0511 will be sunsetted under these updates.
How will telehealth billing change for FQHCs and RHCs starting in October 2026?
Medicare telehealth billing will shift from G2025 to specific CPT codes using modifiers 93 or 95. This aligns with MBPM Chapter 13 and 42 CFR rules.
What ICD-10 updates impact behavioral health claims for FQHCs?
ICD-10 updates for behavioral health codes become effective October 1, 2026. FQHCs must update code libraries to avoid denials related to these changes.
What are the key risks for RPM services in 2026?
RPM continues to grow but carries increased audit risks without proper documentation. Providers should ensure compliance with current billing and record-keeping requirements.
What is CMS proposing for state-directed payments?
CMS proposed capping state-directed payments at Medicare rates with a $775B savings target. The comment period for this rule ended July 21.
FQHC PPS +2.5% to $207.72 with separate APCM; G0511 sunset; MBPM Ch13 tele updates; 42 CFR rules. CMS proposed rule to cap state-directed payments at Medicare rates (comment period ended July 21) with $775B savings target. CMS announced Medicare Telehealth Billing Changes for FQHCs/RHCs—shift from G2025 to specific CPT codes with modifiers 93/95 starting October 2026. CMS created new Office of Health Technology and Products. Important coding note: CPT G2211 bundled into FQHC PPS. Noridian IUD insertion coding update (CPT 58999) effective July 1, 2026. ICD-10 updates for behavioral health codes effective October 1, 2026—FQHCs must update code libraries to avoid denials. Today's reading included a practical guide on BHI CPT codes for 2026, useful for staff education as G0511 sunsets and BHI/RPM codes become more relevant, though FQHC billing is via PPS and APCM, not MPFS.