FQHC Billing in 2026: G0511 Is Gone — Here's What Replaces It

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If your Federally Qualified Health Center or Rural Health Clinic is still billing G0511 for care management services, those claims are being denied. The bundled G0511 code expired September 30, 2025. As of January 1, 2026, FQHCs and RHCs must bill individual CPT codes for CCM, PCM, and RPM — the same codes that private practices have been using all along.

What G0511 covered and what replaces it:

• G0511 bundled CCM and RPM care management into a single monthly code at $145.96/month average. That code is gone.
• FQHCs now bill CPT 99490 ($66.13/month) for CCM, CPT 99457 ($51.77/month) for RPM management, and all associated add-on codes separately.
• CPT 99445 (new in 2026) is eligible for FQHC billing and applies retroactively to January 1, 2026 — meaning FQHCs can bill it for patients who submitted 2–15 days of readings in any month of 2026.

The revenue impact cuts both ways. Some FQHCs will see higher total reimbursement under individual CPT billing — particularly those with patients who qualify for both RPM and CCM separately. Others will see lower revenue if they were relying on G0511 as a catch-all code without optimizing which individual services were being delivered. The key is auditing your patient panel now and rebuilding the billing workflow around the current code structure.

RPM revenue is now additive to the PPS rate for FQHCs — a significant change from prior years when RPM reimbursement was more restricted in FQHC settings. This means RPM programs at FQHCs can now generate meaningful per-patient revenue that didn't exist before, on top of existing PPS payments.

The transition from G0511 to individual CPT codes isn't just a billing change — it's an opportunity to restructure care management programs to maximize revenue under the current framework. FQHCs that make the transition cleanly and document correctly will come out ahead. Those still submitting G0511 claims are generating systematic denials.

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