- PrEP for HIV
Starting September 30, 2024, CMS covers Pre-exposure Prophylaxis (PrEP) using antiretroviral drugs and other related services to prevent HIV. Visit PrEP for HIV & Related Preventive Services.
- End of the COVID-19 Public Health Emergency (PHE)
The COVID-19 PHE ended on May 11, 2023. View RHCs and FQHCs: CMS Flexibilities to Fight COVID-19 for information about the changes to the RHC and FQHC flexibilities.
COVID-19 Vaccines & Billing
Get information about how to bill for COVID-19 vaccines.
Virtual Communication Services & Digital Assessment Services
Starting May 12, 2023, digital assessment services are no longer included in virtual communication services.
Don’t submit claims for digital assessments with dates of service on or after May 12, 2023, using HCPCS code G0071.
Use the following CPT codes for billing digital assessments provided from March 1, 2020 – May 11, 2023:
- 99421 (5-10 minutes over a 7-day period)
- 99422 (11-20 minutes over a 7-day period)
- 99423 (21 minutes or more over a 7-day period)
You must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services to get paid for the digital assessment service or virtual communication services (HCPCS codes G2012 and G2010).
See Virtual Communication Services FAQs (PDF).
- CY 2024 Physician Fee Schedule (PFS) Final Rule Effective January 1, 2024
See below for a list of policies affecting (RHCs/FQHCs) in the CY 2024 Medicare PFS Final Rule.
- Finalized conforming technical changes to extend payment for telehealth services
- Finalized conforming technical changes to delay the in-person requirements for mental health visits
- Extended the definition of direct supervision to permit virtual presence
- Finalized conforming technical changes to include Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) as RHC and FQHC practitioners
- Revised the required level of supervision for behavioral health services furnished “incident to” physician services from direct supervision to general supervision
- Added Remote Physiologic Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Community Health Integration (CHI) and Principal Illness Navigation (PIN) to the general care management code, G0511
- Revised the methodology to calculate the payment rate for HCPCS code G0511
- Clarified that beneficiary consent for Chronic Care Management (CCM) and Virtual Communication may be obtained through general supervision
Read the CY 2024 Medicare Physician Fee Schedule (PFS) Final Rule fact sheet
- CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule Effective January 1, 2024
See below for a list of policies affecting (RHCs/FQHCs) in the CY 2024 Medicare OPPS Final Rule.
- Finalized conforming technical changes to related Intensive Outpatient Program (IOP) benefits and services, certification and plan of care requirements and special payment rules
- Finalized payment for three IOP services per day based on the hospital rate
Read the CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule fact sheet
- Care Management Services
Starting January 1, 2024, care management services provided in RHCs/FQHCs include:
- Transitional care management (TCM)
- Chronic care management (CCM)
- Principal care management (PCM)
- Chronic pain management (CPM)
- General behavioral health integration (BHI)
- Remote physiologic monitoring (RPM)
- Remote therapeutic monitoring (RTM)
- Community Health Integration (CHI)
- Principal Illness Navigation (PIN)
We pay CCM services at the weighted average of the non-facility PFS payment rates for the base code and add-on code pairs, in addition to the individual base codes for all of the services that comprise HCPCS code G0511 by using the most recent PFS utilization data.
RHCs and FQHCs can bill TCM services and general care management services provided for the same patient during the same service period if the RHC and FQHC meet the requirements for billing each code.
We pay psychiatric collaborative care model (CoCM) services at the average of the national non-facility PFS payment rate, either alone or with other payable services, using HCPCS code G0512. We update this rate annually. You must provide at least 70 minutes of psychiatric CoCM services in the first calendar month, and at least 60 minutes in subsequent calendar months to bill for this service.
For questions on FQHC payment policy issues, email FQHC-PPS@cms.hhs.gov.
- CY 2024 Payment Rates
Beginning January 1, 2024 through March 8, 2024, the payment rates for the following codes are:
- G0511: $71.71
- G0512: $144.07
- G0071: $13.10
- G2025: $95.29
Effective March 9, 2024 through December 31, 2024, the payment rates are:
- G0511: $72.90
- G0512: $146.47
- G0071: $13.32
- G2025: $96.87
