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The FQHC Operator · Issue 1 · November 2026
The 2027 PPS rate, telehealth through 2027, and the in-person rule that moved again
The short version: CMS proposes a $212.91 Medicare FQHC PPS base rate for 2027, a 2.5 percent update to $207.72, with the final number to use data through June 2026. Congress extended telehealth payment through December 31, 2027 and pushed the in-person mental health rule to no earlier than January 1, 2028. Final rule expected in November.
$212.91 · proposed 2027$207.72 · CY 2026Dec 31, 2027 · telehealth endsJan 1, 2028 · in-person earliest
Edition
Issue 1 · Nov 2026
Focus
Medicare FQHC PPS
Audience
FQHC finance
Metric
$212.91 proposed
Horizon
Telehealth to Dec 31, 2027
Length
4 min read
$212.91proposed
2027 base rate, $207.72 x 1.025; final to reflect data through Q2 2026 [1]
$207.72CY 2026
Final base rate, itself a 2.5% increase over $202.65 [4]
Dec 31, 2027telehealth
Non-behavioral FQHC and RHC telehealth payment ends under CAA 2026 section 6209(c) [1]
Jan 1, 2028in-person
Earliest date the in-person mental health rule applies [3]
How one Medicare FQHC visit is priced, unchanged by the proposed rule
Payment runs through 2027, and G2025 is already gone
CMS is not proposing changes to 405.2464(g); the billing change took effect this October [1] [3].
| Element | Status | Date |
|---|---|---|
| Non-behavioral telehealth visits payable | Extended, CAA 2026 section 6209(c) [1] | Through December 31, 2027 |
| HCPCS G2025 | Retired [3] | Dates of service through September 30, 2026 |
| CPT or HCPCS code plus telehealth modifier | Required [3] | From October 1, 2026 |
| Home as distant and originating site | Continues [3] | Through the extension |
| In-person visit before mental health telehealth | Does not apply; text at 405.2463(b)(3) and 405.2469(d) [1] | Through December 31, 2027; earliest January 1, 2028 |
| Behavioral health visits by telecommunications | Paid under the PPS [3] | Since January 1, 2022 |
| DSMT and MNT in RHCs | Proposed paid the AIR as stand-alone visits under direct supervision [1] | CY 2027 |
| DSMT and MNT in FQHCs | Already visits under 405.2463; group DSMT not payable [1] | Unchanged |
Four dates to put on the calendar
Nov 2026
Expected
- Final rule; our FQHC PPS rate 2026 guide carries the 2027 figure the day it publishes
Dec 31, 2027
Statutory
- Last day of telehealth payment and of the in-person abeyance [1]
Jan 1, 2028
Earliest
- In-person mental health requirement for FQHC and RHC telehealth [3]
Takeaway
Make the base rate one cell, then audit October for G2025. The 2027 increase only arrives if the encounter charge clears the rate.
The 30-minute check, in order
Open the expected-payment tableConfirm the Medicare FQHC base rate is a single parameter, not a number typed into formulas.
Search October for G2025Every Medicare telehealth line dated October 1, 2026 or later; anything found will be returned, so fix the template.
Re-price chargesIf encounter charges sit below $207.72 times your GAF, Medicare pays the lower charge.
Read the two new FQHC piecesThe FQHC APM versus PPS decision guide (the floor, the 2026 SPAs, eight board questions) and the FQHC KPI scorecard (12 KPIs with formula and owner).
Frequently asked questions
Is $212.91 the final 2027 Medicare FQHC rate?
No. It is $207.72 times a proposed 2.5 percent market basket update, and CMS says the final update will reflect data through the second quarter of 2026. Wait for the final rule, expected in November 2026.
Can we still bill G2025 for telehealth?
Not for dates of service on or after October 1, 2026. CMS's October 2026 FAQ says RHCs and FQHCs bill the individual CPT or HCPCS code with the telehealth modifier from that date, and that non-behavioral telehealth stays payable through December 31, 2027.
When does the in-person mental health visit rule hit FQHCs?
Not before January 1, 2028. The CAA, 2026 holds the requirement in abeyance through December 31, 2027 and the proposed rule writes that date into 42 CFR 405.2463(b)(3) and 405.2469(d).
- Federal Register: CY 2027 PFS proposed rule, 91 FR 43842 (July 16, 2026), RHC and FQHC provisions
- CMS fact sheet: Calendar Year 2027 Medicare Physician Fee Schedule proposed rule (July 14, 2026)
- CMS Telehealth FAQ, updated October 8, 2026 (posted October 9, 2026)
- CMS MLN Matters MM14309: FQHC PPS and IOP payment rates, CY 2026 update (December 5, 2025)
- CMS, FQHC PPS Frequently Asked Questions (lesser-of rule, 34.16 percent adjustment)
Checked October 25, 2026. Proposed rules are not final until published; confirm against the source before relying on a number.
Want your 2027 Medicare FQHC tables checked before January?
We review the rate tables, telehealth templates and charge master against the proposed rule now and the final rule when it publishes, and show you what will return before it does.