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CY 2027 PFS proposed rule: what it does to FQHC and RHC payment

Short answer: a proposed $212.91 base rate, telehealth payment confirmed through December 31, 2027, the in-person mental health rule pushed to 2028, and DSMT and MNT as stand-alone RHC visits. Everything is proposed until the final rule, expected November 2026.
$207.72 x 1.025 = $212.91CAA 2026 § 6209(c) telehealthCAA 2026 § 6209(d) in-person abeyanceProposed · final rule Nov 2026

October 27, 20265 min readASP-RCM Solutions

Edition
Oct 2026
Focus
CY 2027 PFS
Audience
FQHC · RHC finance
Metric
$212.91 proposed base
Horizon
Telehealth to Dec 31, 2027
Length
5 min read
$212.91proposed base
CY 2027 FQHC PPS base rate, $207.72 x 1.025; final figure to use data through Q2 2026 [1]
Dec 31, 2027telehealth
Last date for FQHC and RHC non-behavioral telehealth payment under CAA 2026 section 6209(c) [1]
Jan 1, 2028in-person
Earliest date the in-person mental health visit requirement applies to FQHC and RHC telehealth [3]
2.5%market basket
Proposed FQHC update; CY 2026 was itself 2.5% over $202.65 [4]
The rate

Three years of base rate, one proposed

Medicare FQHC PPS base rate, final years and the proposed CY 2027 figure

Sources [4] [1]. The new patient, IPPE and AWV adjustment and the GAF are untouched [6].
$202.65baseline
CY 2025final
$207.72+2.5%
CY 2026final
$212.91+2.5% proposed
CY 2027proposed, not final
FinalProposed
$319.38CY 2026 IOP rate for three or fewer services; $418.45 for four or more [4]
$33.17 / $32.84Proposed conversion factors for APM participants and others, down 1.19 and 1.68 percent; FQHC care management codes paid at PFS rates feel that [2]
One cellMake the base rate one cell you change when the final rule publishes
Telehealth and behavioral health

The dates, as the law and CMS state them

  1. 1
    Jan 1, 2022Behavioral health visits by telecommunications paid under PPS or AIR [3]
  2. 2
    Feb 3, 2026CAA 2026 enacted; sections 6209(c) and (d) set the dates [1]
  3. 3
    Jul 16, 2026CY 2027 PFS proposed rule with conforming text at 405.2463(b)(3) and 405.2469(d) [1]
  4. 4
    Sep 30, 2026G2025 last valid date of service [3]
  5. 5
    Dec 31, 2027Telehealth payment extension and in-person abeyance both end [1]
  6. 6
    Jan 1, 2028Earliest in-person requirement for FQHC and RHC mental health telehealth [3]
Non-behavioral telehealth
Paid at national average PFS telehealth rates, outside the PPS [6]
G2025
Retired after September 30, 2026; individual code plus modifier from October 1
In-person rule
Held in abeyance under 6209(d)
Telehealth paymentCode changeAbeyance
Dates table

FQHC and RHC telehealth dates after CAA 2026, as stated by CMS

ItemDateSource
Non-behavioral telecommunication visits payableThrough December 31, 2027 [1] [3]
G2025 last valid date of serviceSeptember 30, 2026 [3]
Individual CPT or HCPCS code plus telehealth modifierDates of service from October 1, 2026 [3]
Home and any geographic location as distant and originating siteContinues for FQHC and RHC telecommunications services [3]
In-person requirement for mental health telehealth visitsNot before January 1, 2028 [1] [3]
Audio-only telehealth in the homeThrough December 31, 2027 under current law [3]
DSMT, MNT and housekeeping

What else the rule touches

RHC: DSMT and MNT stand alone

Proposed

  • Paid the all-inclusive rate as stand-alone visits, under direct supervision of RHC staff [1]

FQHC: already a visit

405.2463(a)(2)(ii)

  • Face-to-face encounter with a qualified MNT or outpatient DSMT provider [5]
  • Group DSMT not payable; PPS is limited to individual face-to-face encounters [1]

Cross-references and wording

405.2464

  • (b)(1) and (2) corrected to point at the right payment provisions [1]
  • In (g), "an encounter" becomes "services", which matters for telecommunication lines [1]

Modalities aligned

405.2469(d)

  • Telecommunications modalities and in-person requirements aligned with 405.2463 [1]
  • Aligns RHC payment with FQHCs and physician offices [2]
Takeaway

Do not load $212.91 into expected-payment tables yet, and keep the in-person scheduling capability on the shelf. The 2028 date is set by statute and has moved several times.

What to do this week

Before the final rule publishes, five actions by owner

Parameterize the base rateFinance systems: the final figure will differ from $212.91 if Q2 2026 data moves the market basket.
Audit October telehealth lines for G2025Billing: G2025 is invalid for dates of service from October 1, 2026 [3].
Re-price encounter charges for 2027Charge master: Medicare pays the lesser of charge or rate, so a stale charge caps the increase.
Confirm MNT and DSMT templates bill as individual FQHC visitsCoding: group DSMT is not payable under the FQHC PPS [1].
Calendar December 31, 2027Compliance: telehealth payment and the in-person abeyance both end that day under current law.
Check the referencesPPS rate 2026 guide, rate calendar, new patient add-on, The FQHC Operator, FQHC billing services.
FAQ

Frequently asked questions

What is the proposed CY 2027 Medicare FQHC PPS base rate?

$212.91. The proposed rule multiplies the CY 2026 base rate of $207.72 by a proposed 2.5 percent FQHC market basket update. CMS says the final update will reflect historical data through the second quarter of 2026, so the number can move in the final rule, which is expected in November 2026.

Does the proposed rule change FQHC telehealth payment?

No new policy. Section 6209(c) of the Consolidated Appropriations Act, 2026 extended payment for FQHC and RHC non-behavioral health telecommunication visits through December 31, 2027, and CMS says it is not proposing modifications to 42 CFR 405.2464(g). Payment stays at the national average PFS telehealth rate, outside the PPS.

When does the in-person mental health visit requirement start for FQHCs?

Section 6209(d) of the CAA, 2026 keeps the requirement in abeyance through December 31, 2027, and CMS proposes conforming text at 405.2463(b)(3) and 405.2469(d) so that it does not apply to any services furnished through that date. CMS's October 2026 FAQ says in-person requirements will not apply until at least January 1, 2028.

What changes for DSMT and MNT?

For RHCs, CMS proposes to recognize DSMT and MNT as qualified preventive services paid the all-inclusive rate as stand-alone billable visits when furnished by a certified provider under direct supervision. FQHCs already have DSMT and MNT visits in 42 CFR 405.2463; the proposal aligns RHC payment with FQHCs and physician offices.

Sources
  1. Federal Register: CY 2027 PFS proposed rule, 91 FR 43842 (July 16, 2026), RHC and FQHC section
  2. CMS fact sheet: Calendar Year 2027 Medicare Physician Fee Schedule proposed rule (July 14, 2026)
  3. CMS Telehealth FAQ, updated October 8, 2026 (posted October 9, 2026)
  4. CMS MLN Matters MM14309: FQHC PPS and IOP payment rates, CY 2026 update (December 5, 2025)
  5. 42 CFR 405.2463, What constitutes a visit (eCFR)
  6. 42 CFR 405.2464, Payment rate (eCFR)

Checked October 25, 2026. Rules change, and proposed rules are not final until CMS publishes them; confirm against the source before relying on them.

Related

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