The FQHC PPS rate for 2026.

How the 2026 rate was setOne base rate, updated by a market basket.

Section 1834(o) of the Social Security Act pays FQHCs a single national encounter rate under Medicare Part B: the lesser of the center's actual charges or the PPS rate, for all FQHC services furnished to a patient on the same day as a medically necessary face-to-face visit. Since 2017 CMS has updated the base rate every January 1 by the FQHC market basket. For CY 2026 that update is 2.5%, based on historical data through the second quarter of 2025.

Geographic adjustmentThe GAF math, worked out.

The base rate is adjusted for each FQHC by the Geographic Adjustment Factor (GAF), which CMS adapts from the work and practice expense Geographic Practice Cost Indices used in the Physician Fee Schedule. The GAF applies to the base rate only, runs on a calendar year, and is published as a locality file with each annual update. Here is CY 2026 for one locality, end to end.

The spread across localities is real money. Sample GAF values from the CMS CY 2026 FQHC GAF file:

The payment codesEvery FQHC G code and what it pays.

FQHC claims must carry one of the CMS specific payment codes. The code does not carry its own fee; it tells the FQHC Pricer which version of the PPS math to run. Two adjacent codes, G0511 and G2025, are in transition and worth a careful read.

What this means for your revenueThe rate is national. The leakage is local.

Knowing the 2026 rate is table stakes. FQHC revenue is won or lost in three places this page's math feeds directly: the Medicaid wrap, the metric you manage to, and the charge master. This is where ASP-RCM's FQHC practice spends its time.

1. The Medicare PPS is not the Medicaid PPS, and the wrap lives in the gap.

The $207.72 on this page is Medicare. Your state Medicaid program pays its own FQHC PPS rate under Section 1902(bb) of the Social Security Act, and when a Medicaid managed care organization pays less than that rate per encounter, the state owes you a wraparound payment for the difference. Wrap is where FQHC money quietly disappears: encounters that never make the wrap file, MCO takebacks that never reverse out, reconciliations that close late or never. Across one 7-site FQHC, ASP-RCM's wrap reconciliation work recovered $2.1M in wrap value that was owed and unpaid. The step-by-step method is in our wrap payment reconciliation guide and the engagement detail is in the FQHC wrap reconciliation case study.

2. GCR will lie to you under PPS. Manage to NCR.

Gross collection rate divides cash by gross charges. Under PPS your payment is set by the encounter rate, not your charges, so a center with a healthy fee schedule mechanically shows a "bad" GCR while collecting every dollar it is owed, and a center that under-prices its charge master shows a "good" GCR while capping its own Medicare payments through the lesser-of rule. The right lens is net collection against expected value: PPS rate math on the Medicare side, PPS-plus-wrap on the Medicaid side. We wrote the framework up in the FQHC NCR framework white paper.

3. The 2026 numbers set your expected-value tables.

ASP-RCM runs revenue cycle for FQHCs on exactly this stack: PPS-plus-wrap expected value by encounter, NCR governance instead of GCR theater, charge master repricing every rate year, and credentialing tied to billable status. Start at the FQHC practice hub or the FQHC revenue cycle field guide.

Primary sourcesEvery figure, traced.

Each number on this page was verified against the CMS or federal document below before publication. Confirm the current version before acting; recurring update notifications supersede prior years.