What is an FQHC?

Federally Qualified Health Centers (FQHCs) are community-based healthcare providers that receive federal funding to deliver primary care services in underserved areas. FQHCs focus on providing comprehensive, accessible, and affordable care to patients regardless of their ability to pay, often serving as a lifeline for low-income or rural populations.

RHCs (Rural Health Clinics) serve a similar purpose, addressing healthcare disparities in rural communities by improving access to primary care and other essential health services.

Can FQHCs and RHCs Bill for RPM?

Yes! Starting in 2024, CMS expanded the scope of services billable by FQHCs and RHCs under HCPCS code G0511 to include Remote Patient Monitoring (RPM). This is a significant step forward, as RPM was previously unavailable as a reimbursable service for these facilities.

Key Highlights of RPM Billing for FQHCs and RHCs:

1. 2024 Updates:
   • RPM was added to G0511, which previously included other care management services like Chronic Care Management (CCM) and behavioral health integration.
   • G0511 now reflects the additional resources required for RPM services, such as the use of connected devices to collect and transmit patient data.
2. 2025 Updates:
   • CMS finalized the unbundling of G0511, allowing FQHCs and RHCs to bill for existing RPM-specific care management CPT codes.
   • This enables providers to bill accurately for RPM services without the limitations of a bundled code, paving the way for better reimbursement opportunities.

How Much Can FQHCs and RHCs Earn Through RPM?

Under the 2024 PFS, FQHCs and RHCs billing for RPM services are reimbursed at the national non-facility Medicare payment rate, with the following approximate amounts:

• $146 per patient, per month for services like RPM and CCM.
• This amount is lower than non-FQHCs/RHCs, which can bill up to $202 per patient, per month.

With the unbundling of G0511 in 2025, FQHCs and RHCs can now:

• Bill multiple RPM care management codes per month based on the time and services provided.
• Earn additional revenue by delivering advanced care management services, such as personalized patient plans and ongoing monitoring.

What Are the Benefits of RPM Billing for FQHCs and RHCs?

Adding RPM as a billable service allows FQHCs and RHCs to:

1. Enhance Patient Care: RPM enables proactive management of chronic conditions like hypertension, diabetes, and heart disease, improving outcomes for underserved populations.
2. Increase Reimbursement Potential: The ability to bill multiple care management codes ensures providers are fairly compensated for the time and effort spent delivering RPM services.
3. Expand Service Offerings: RPM adoption helps FQHCs and RHCs provide modern, technology-driven care to patients who may not have access to regular in-person visits.