PPS payment codes
Every Medicare claim needs an FQHC payment code. CMS pays 80% of the lesser of your charges or the adjusted PPS rate, and the CY 2026 base rate is $207.72 before geographic, new patient, and wellness visit adjustments.
One encounter rate, many rules about what counts
Medicare pays federally qualified health centers a per-visit PPS rate tied to an FQHC payment code, not a fee for each service. Care coordination, telehealth, and same-day visits each follow their own rules, and several changed in 2026.
Book a demoHow a health center visit gets paid
CMS lays out the Medicare rules in its FQHC booklet and its FQHC and RHC announcements.
Same-day visits
Several visits on one day usually count as one encounter. Exceptions include a later illness or injury, a medical and a mental health visit, and a dental visit alongside a medical one.
2026 coding changes
G0511 and G0512 are gone, so care management is billed with individual codes at the national non-facility rate. For dates of service on or after October 1, 2026, distant site telehealth moved from G2025 to individual codes with modifier 93 or 95.
Keep compliance close, move the claim work
Health centers carry reporting duties that sit outside billing. The claim cycle can be scoped on its own.
What the health center keeps
Sliding fee scale decisions, the annual cost report, grant reporting, and clinical documentation stay with your team.
What Taiga takes on
Where it fits, Taiga checks eligibility, scrubs and submits claims, works every denial and appeal, and handles patient statements and follow-up.
Where a decision is needed
Medicaid and managed care visit rules, care coordination claims, and telehealth coding need an owner, since each follows a different payment path.
Questions for an FQHC fit call
Bring de-identified examples of a Medicare PPS claim, a Medicaid claim, and a care management claim. Do not include patient details in the booking form.
What is your payer mix?
Estimate Medicare, Medicaid, managed care, commercial, and self-pay shares.
Which sites and services?
List medical, behavioral health, dental, and mobile or school sites, and which ones you want in scope.
Have you moved off G2025?
Say how your team updated telehealth coding for visits on or after October 1, 2026, and whether any claims are stuck.
For health centers with a stretched billing office
Worth a call for a community health center whose team is short on time for denials, aging Medicaid balances, and the 2026 coding changes.
Encounter billing needs a direct answer
Taiga has not published support for FQHC encounter billing. This page does not cover cost reports, Medicaid supplemental payments, or grant compliance, and it is not billing advice.
Questions about FQHC billing
Can an FQHC bill CCM and TCM for the same patient in the same period?
Yes. CMS says health centers can bill CCM and TCM for the same patient during the same period, and pays care coordination codes at the national non-facility rate.
Is G0511 still valid?
No. CMS terminated G0511, and G0512 and G0071 stopped being reportable on January 1, 2026. Bill the individual care management codes instead.
How do we bill telehealth visits now?
For dates of service on or after October 1, 2026, report the individual CPT or HCPCS code with modifier 93 for audio-only or 95 for audio-video, instead of G2025. Mental health visits by telehealth are paid like in-person visits.
How is patient coinsurance figured at an FQHC?
Coinsurance is 20% of the lesser of your charges or the PPS rate for the payment code. CMS waives coinsurance and the deductible for certain preventive services, including specific wellness visits.
Bring your health center's billing picture
Share your sites, payers, and where claims back up. Taiga will tell you straight whether the work fits.
System guides show possible billing handoffs, not proven specialty compatibility.