FQHCs Must Get Creative with Building and Sustaining Remote Patient Monitoring Programs

Medicare RPM policy update (November 1, 2026): This October 2023 article discusses an earlier stage of FQHC and Rural Health Clinic (RHC) reimbursement policy; it is not current billing guidance. CMS ended HCPCS G0511 billing for RHC/FQHC care-coordination services after September 30, 2025, and now requires the applicable individual CPT or HCPCS codes for eligible services. CMS’s 2026 guidance also addresses code-specific remote monitoring requirements. Verify covered services, documentation, and payer-specific rules before billing. Official sources: CMS G0511 transition notice, CMS FQHC/RHC updates and CMS remote monitoring guidance.

Federally qualified health centers (FQHCs) are an important safety net for individuals who often do not have easy access to primary and preventive care. With a mission to ensure the delivery of high-quality, comprehensive health care services to these underserved communities, many FQHCs are now choosing to leverage technology – like remote patient monitoring (RPM) – to reach more individuals and take a proactive approach to their care that results in better outcomes and minimizes health care overall costs.

RPM’s role in improving access to care

Since the COVID-19 pandemic, incorporating RPM into a patient’s care has proven extremely effective for FQHCs. Services can be extended beyond traditional in-person visits, which is particularly important when monitoring patients for high blood pressure, diabetes, heart failure, asthma and other chronic conditions. The patient-generated data also enhances continuity of care, allowing clinicians to identify potential red flags before they escalate into more complicated problems. By having a holistic view of the patient and taking proactive measures, FQHCs can ultimately reduce overall health care costs for both the patients and payers.

Yet, despite the early successes with RPM deployments and the obvious benefits from the initial grant funding FQHCs received for RPM projects and specific disease management initiatives during the pandemic, FQHCs still face significant uncertainty about how to pay for these beneficial programs long term, as those grants are limited in scope and duration.

Overcoming current obstacles in RPM reimbursement

At the time of this October 2023 article, Medicare reimbursement for remote patient monitoring (RPM) in FQHCs and Rural Health Clinics (RHCs) faced substantial limitations. Subsequent CMS changes introduced separate reporting of eligible care-coordination services in these settings. The historical discussion here should not be used to determine current claims. Medicaid RPM benefits, covered devices, and FQHC eligibility vary by state and should be checked against each program’s current guidance.

To keep RPM programs running, and potentially consider expanding their use, FQHCs have needed to find creative ways to pay for them. Among the approaches are:

• Incorporating eligible chronic care management (CCM) services – The original funding approach referred to HCPCS G0511, a historical FQHC/RHC care-management code that CMS permitted only through September 30, 2025. Clinics can consider eligible CCM and remote monitoring services under the current individual CPT/HCPCS codes when each service meets Medicare requirements, with no duplicate counting of time or services.
• Generating additional in person visits according to medical necessity based on RPM data – The CMS Prospective Payment System (PPS) payment model reimburses FQHCs based on a predetermined, fixed rate per patient visit or encounter. The intent of PPS is to cover the costs of providing a comprehensive range of primary and preventive health care services so that FQHCs have a stable and predictable funding source to provide essential, appropriate health care services to their communities. In some cases, these payments can help support RPM programs. For example, TrueCare in San Diego indicated that PPS reimbursements will help sustain its current, successful RPM program for hypertension if engagement in the program results in one extra in-person visit for every 13 patients using RPM. These in-clinic visits are often needed to assess symptoms, complications or medication adjustments that are identified through the RPM program.
• Bolstering grant applications with data on patient outcome improvements – Grants play an important role in enabling FQHCs to support patients and employ state-of-the-art solutions. FQHCs with existing RPM programs should leverage the data they collect and track patient progress to show the positive impact of remote monitoring on patient outcomes. Real-world results and examples of successful deployments will strengthen the case for FQHCs to win grants to continue support, or enhance, RPM programs. For example, a large FQHC in California was able to build their RPM program through successive grants leveraging outcomes achieved. After their initial Hypertension grant from HRSA in 2021, the FQHC was able to secure an Optimizing Virtual Care (OVC) Grant in 2022, which allowed them to expand RPM to diabetes. When submitting for the OVC grant, they used the success of their hypertension pilot program.

New hope for Medicare reimbursements for RPM at FQHCs in 2024

When this article was published in October 2023, the CY 2024 Medicare Physician Fee Schedule proposal signaled possible changes to FQHC reimbursement for RPM. CMS subsequently finalized Medicare payment changes and phased out the former G0511 reporting pathway. For services after September 30, 2025, eligible RHCs and FQHCs must use the applicable individual care-coordination CPT/HCPCS codes. Medicare policy changes do not automatically establish coverage under a state Medicaid program; clinics should check the current rules and actual eligible services with each payer.