For FQHCs & Rural Health Clinics
Remote Patient Monitoring and Care Management for FQHCs and RHCs
Since 2025, health centers bill care management with the same individual codes physician practices use, and CMS pays them on top of your encounter rate. We run the programs with cellular devices that work where broadband doesn’t.
HIPAA · SOC 2 Type II
No long-term contract
Live in about 30 days
Paid outside PPS / AIRBilled at PFS non-facility rates
Health center program, this monthLive
Hypertension patients on RPMCellular cuffs, no app96
APCM patientsG0557, monthly bundle210
Billable months completedLogged by code93%
Escalations to your providerSame-day review7
2,000+Providers on HealthArc
100,000+Patients monitored
45+States covered
9CMS programs, one platform
What Changed
G0511 Is Gone, and the Replacement Pays Health Centers Differently
For years FQHCs and RHCs billed almost every care-management service through one code, G0511.
That ended in 2025. CMS moved health centers onto the individual CPT and HCPCS codes, with a grace period that ran to July 1, 2025, and the CY 2026 Physician Fee Schedule terminated G0511 outright.
The new codes are paid at the national non-facility fee schedule rate, in addition to your PPS or AIR payment. That means each program now has its own documentation rules, and each one has to be tracked separately.
It’s more work.
It’s also more money for most health centers, because RPM and APCM can now be billed for the same patient population that used to sit under a single G0511 line, and both pay outside the encounter rate your PPS or AIR already covers.
G0511
Terminated in the CY 2026 PFS
Billing since 2025
Individual CCM, RPM, APCM codes
APCM for health centers
G0556–G0558, from Jan 1, 2025
Paid
On top of PPS or AIR
Each code has its own rules
RPM needs 16 days of readings. CCM needs 20 documented minutes. APCM needs the service elements in place. One code used to cover all of it.
Patients are far away
Rural patients may drive an hour to the clinic and have no home internet. Bluetooth devices that need a phone don’t work for them.
Care teams are already stretched
Health centers run on tight staffing and grant reporting. A new monthly program can’t depend on a nurse who’s also covering walk-ins.
Grant and UDS reporting never stops
Hypertension and diabetes control are reported every year. Data from between visits only helps if it lands somewhere your reporting team can use it.
Programs That Fit
Programs Health Centers Can Bill Now
These are the programs we run most often with FQHCs and RHCs. Each is billed with its own code and paid separately from the encounter.
Remote Patient Monitoring
Cellular blood pressure cuffs and glucometers for hypertension and diabetes, the two conditions that drive most UDS clinical measures.
CPT 99453, 99454, 99457, 99458
Advanced Primary Care Management
A monthly bundle with no minute counting. RHCs and FQHCs have been able to bill it since January 1, 2025. Our APCM guide for hospitals and FQHCs covers the service elements.
HCPCS G0556, G0557, G0558
Chronic Care Management
Time-based care-plan work for patients with two or more chronic conditions who aren’t on APCM.
CPT 99490, 99439, 99487, 99489
| Before 2025 | 2025 | 2026 | |
|---|---|---|---|
| CCM, RPM, PCM, RTM | G0511, one rate | Individual codes (G0511 allowed until July 1) | Individual codes only; G0511 terminated |
| APCM | Not available | G0556–G0558 billable | Billable, plus BHI add-ons G0568–G0570 |
| How it’s paid | Flat G0511 amount | PFS non-facility rate, outside PPS/AIR | PFS non-facility rate, outside PPS/AIR |
Sources: CMS FQHC and RHC announcements and the CY 2025 and CY 2026 Physician Fee Schedule final rules. Coinsurance rules differ between RHCs and FQHCs; check with your MAC before you bill. Our G0511 guide covers the old code in more detail.
How It Runs
Run by Our Team, Under Your Health Center’s Name
Most health centers use the managed model. Our clinical team does the outreach and monthly work, and your providers keep clinical oversight.
Devices that work without broadband
- FDA-cleared cellular cuffs, glucometers and scales
- No smartphone, Wi-Fi or app needed
- Shipped activated to the patient’s home
- We handle replacements and troubleshooting
A care team working under your name
- RNs, LPNs and enrollment specialists
- Calls made under your health center’s name
- Escalations follow your clinical protocol
- Your providers keep clinical oversight
Reporting you can use
- Monthly billing report by patient and code
- Blood pressure and A1c trends by panel
- Data for UDS hypertension and diabetes measures
- Export for grant and board reporting
We don’t give grant or coding advice. We give you the documentation and the reports; your billing team and MAC have the final say on what gets submitted.
Evaluating Vendors
What Health Centers Ask Before Choosing a Care Management Partner
Questions we hear from FQHC and RHC leadership, with plain answers.
| The question | Our answer |
|---|---|
| Can FQHCs bill RPM separately from the encounter? | Yes. Since 2025 RPM is billed with the individual CPT codes and paid at the PFS non-facility rate, in addition to the PPS payment. |
| Do we still use G0511? | No. G0511 is terminated under the CY 2026 Physician Fee Schedule. Use the individual CCM, RPM, PCM, RTM and APCM codes. |
| Can an RHC bill APCM? | Yes. RHCs and FQHCs can bill G0556, G0557 and G0558 since January 1, 2025. APCM can’t be billed for a patient in the same month as CCM or PCM. |
| Our patients don’t have internet. Will monitoring work? | Yes. Our devices use a built-in cellular connection, so readings arrive without Wi-Fi, a phone or an app. |
| Who does the monthly calls? | Our clinical team, under your health center’s name, unless you’d rather staff it yourself. Your providers set the escalation rules. |
| Which EHRs do health centers use with you? | eClinicalWorks, NextGen, athenahealth, Epic and others. Readings and notes write back to the chart. |
Implementation
Live in About 30 Days, Starting With One Program
We usually start with hypertension RPM or APCM, then add the next program once the first is steady.
1
Week 1
Size the eligible panel
We identify patients by condition and program eligibility and estimate what each program could bill outside PPS or AIR.
2
Week 1–2
Agree protocols and connect the EHR
Escalation rules and call scripts are agreed with your medical director. EHR integration runs in parallel.
3
Week 2–3
Enroll patients and ship devices
Our team calls patients, records consent and ships activated cellular devices.
4
Week 4 onward
Run, report and bill
Monthly contact and reviews are logged by code. Your billing team gets the claim-ready report at month end.
FAQ
FQHC and RHC Care Management Questions
What health center leaders ask us most about billing and running remote care programs.
What replaced G0511 for FQHCs and RHCs?
The individual codes for each service: CPT 99490 and related codes for CCM, 99453 to 99458 for RPM, 99424 to 99427 for PCM and G0556 to G0558 for APCM. CMS allowed G0511 until July 1, 2025 and terminated it in the CY 2026 Physician Fee Schedule.
Can FQHCs bill remote patient monitoring?
Yes. FQHCs and RHCs bill RPM with CPT 99453, 99454, 99457 and 99458. Payment is based on the national non-facility fee schedule rate and comes in addition to the PPS or AIR encounter payment.
Is APCM a good fit for a community health center?
Often, yes. APCM pays a monthly bundle without minute counting, which suits health centers that already deliver team-based primary care. A patient on APCM can’t also be billed for CCM or PCM in the same month, so pick one per patient.
How do rural health clinics handle remote monitoring without broadband?
With cellular devices. They connect over a built-in cellular network, so the patient only needs to take the reading.
Does remote patient monitoring help with UDS measures?
It can. RPM gives you more frequent blood pressure and glucose readings between visits, which supports the UDS hypertension control and diabetes measures. Your reporting team decides how the data is used.
Who We Serve
Built for Other Kinds of Organizations Too
Clinics & Physician Practices
RPM and CCM for independent and multi-site practices, staffed or software-only.
Hospitals & Health Systems
Post-discharge monitoring and TCM aimed at the six HRRP conditions.
Value-Based Care Organizations
Between-visit execution for ACOs, MSSP participants and LEAD applicants.
Get Started
Find Out What Your Health Center Can Bill Outside PPS
We’ll size your eligible panel and show the monthly revenue under the new codes.
- Eligible-patient estimate by program
- Billing walkthrough under the 2026 rules
- Device plan for patients without broadband
- No contract required for the estimate
Schedule a Demo
Estimate Your Revenue
HIPAA Compliant • SOC 2 Certified • No long-term contracts
sales@healtharc.io • +1-201-885-5571
sales@healtharc.io • +1-201-885-5571
Talk to a Remote Care Specialist
How Can HealthArc Help You?
Want a demo, or just have a question about remote care in your practice? Send us a few details and a remote care specialist will get back to you shortly.
- RPM, CCM & 7 more CMS programs
- Automated time tracking & CPT billing
- Two-way EHR integration
- Managed care team, or your own
- Pre-configured cellular devices shipped
- Live in about 30 days
HIPAA compliant SOC 2 Type II No long-term contracts
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Resources
Reading for Health Center Teams
Guides to care management programs, billing changes and running them with a small team.
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