2025 FQHC Changes Seek to Improve Patient Access to Care

Recent FQHC changes introduced by the Centers for Medicare and Medicaid Services (CMS) reflect an urgent need to improve patient access to care in rural communities. According to a 2024 survey by The Commonwealth Fund, more than 70% of Federally Qualified Health Centers (FQHCs) face staffing shortages. These centers, which primarily serve low-income patients in underserved and rural communities, provide an essential service by offering low-cost, high-quality care.

The rise of telehealth has been a significant benefit for FQHCs, with 96% reporting that they offer telehealth services (as compared with just 62% in 2018). In addition to serving primary care needs, telehealth services can help patients access specialty care that would otherwise be inaccessible.

Despite the shift toward remote care, the physician shortage crisis remains a critical challenge for FQHCS and community health centers. That’s especially true when telehealth services are limited by a lack of patient access to technology or internet services.

The solution is complex and multi-faceted, but it starts with implementing FQHC changes to address some of the most pressing challenges.

Public Health Challenges for FQHCs

While FQHCs continue to improve access to care for millions of patients, they face some significant challenges that could impact their ability to provide quality care. These include:

Staffing – As mentioned above, the majority of FQHCs are understaffed and may struggle to coordinate care with specialists and other providers.
Telehealth Implementation Costs – The high cost of implementing telehealth services and maintaining a platform is prohibitive for many centers.
Insufficient Reimbursements – Medicare and Medicaid reimbursements for remote care may not align with funding for in-person care and may not always provide enough funding to cover program costs.

CMS Introduces 2025 FQHC Changes to Improve Support

The good news is that steps are already being taken to address some of the funding and reimbursement challenges associated with remote care and telehealth services at FQHCs. Key FQHC changes for 2025 included:

Splitting of G0511 Code: CMS has finalized the phase-out of the current “all-encompassing” code G0511 that FQHCs and RHCs have used to bill for both CCM and RPM services. Moving forward, these centers will need to use separate billing codes for each service, similar to traditional ambulatory practices. This will enable more specific reimbursement based on the care provided.For example, FQHCs and RHCs will need to use CPT 99490 for CCM services instead of G0511, which previously covered both CCM and RPM functions. FQHCs and RHCs will be given a six-month grace period and have until July of 2025 to fully make the switch.
Increased Billing Flexibility: This change allows FQHCs and RHCs to bill more accurately for a broader range of care management and remote monitoring services, reflecting the specific care provided to patients.
Use of Standard Billing Codes: FQHCs and RHCs will now use the same CCM and RPM codes as other healthcare providers, such as CPT 99490 for CCM services.
Focus on Care Coordination: The primary goal of these changes is to enhance care coordination and enable FQHCs and RHCs to manage chronic conditions more effectively through remote monitoring and comprehensive care plans.

2025 Reimbursement Rate Update:

The 2025 Medicare reimbursement rate has decreased, primarily due to the expiration of a temporary payment increase in 2024. This has triggered a budget neutrality requirement, which led to a 2.83% reduction in physician payments for 2025.

RPM Changes for 2026:

The AMA’s CPT Editorial Panel has announced updates for RPM that will go into effect in January 2026. Key revisions include:

A new CPT code for remote patient monitoring device supply will cover 2-15 days of collected and transmitted data. The existing CPT 99454 will be updated to cover 16-30 days.
CPT 99457 will now cover 11-20 minutes of interactive communication with the patient or caregiver, reducing the current 20-minute requirement.

What This Means for RPM and CCM Programs

These changes are designed to enhance the efficiency and impact of RPM and CCM programs by providing clearer billing guidelines, improving care coordination, and offering greater flexibility. For the first time, remote patient monitoring programs are fully available to FQHCs, presenting an opportunity to increase patient satisfaction, reduce hospital admissions, and open a significant new revenue stream.

However, with the transition of the CCM code from G0511 to 99490, most regions will experience a decrease in reimbursement. On average, this reduction amounts to just over $10 per patient per month, and in some areas, it could be even higher compared to the previous rate of G0511, which was $72.98.

Remote Patient Monitoring programs provide an excellent opportunity to make up for that decline in CCM reimbursement in 2025 and beyond. At HealthXL, we support FQHCs and community health clinics with high-caliber CCM and RPM service models, delivering better reimbursement rates and improved patient outcomes over time for our clients.