Key CMS Final Rule 2026 Changes for Rural Healthcare

Some final changes to the 2026 PFS that impact rural hospitals, clinics, and providers are outlined below.

RHC and FQHC Coding Changes

PFS updates will let rural health clinics (RHCs) and federally qualified health centers (FQHCs) use new optional add-on billing codes for behavioral health integration (BHI) and psychiatric collaborative care services model (CoCM) services when they provide advanced primary care. As part of this change, starting January 1, 2026, RHCs and FQHCs have to report individual codes for CoCM and the communications technology-based services (CTBS) and remote evaluation services, HCPCS codes G0512 and G0071.

CMS has adopted a new policy to pay a separate payment to RHCs and FQHCs for PFS services deemed as care management services that will now be deemed as care coordination services.

It will also let RHC and FQHCs use real-time two-way audio and video telehealth (not audio only) for services that need direct supervision. And they can bill for telehealth for all but behavioral health visits using HCPCS code G2025 for audio and video visits (not audio only after December 31, 2025).

Starting January 1, 2026, CTP G0512 and G0071 were deleted and unbundled into new codes.

CTP G0512 was unbundled into:

• CPT 99492 — initial psychiatric CoCM, first month
• CPT 99493 — subsequent months psychiatric CoCM
• CPT 99494 — CoCM add-on time
• HCPCS G2214 — psychiatric CoCM “short month” option

CMS also created add-on codes for APCM that can be used when CoCM is part of APCM provided by the same clinician in the same month.:

• G0568 — initial CoCM services add-on for CPT 99492
• G0569 — subsequent CoCM add-on for CPT 99493
• G0570 — BHI services add-on for CPT 99484

G0071 was unbundled into:

• HCPCS G2012 — virtual check-in
• HCPCS G2010 — remote evaluation
• CPT 99421, 99422, and 99423 — online digital E/M

These changes offer more billing and revenue options, an expanded patient pool, continued support for telehealth, and more accurate payments. You want to pay attention to coding and documentation and potentially train staff on the telehealth model and billing.

Rate Setting and Conversion Factor Changes

Starting in 2026, there will be separate Medicare conversion factors for qualifying alternative payment model (APM) participants (QPs) and non-QPs. Changes result in a 2026 conversion factor of $33.57 for QPs (a 3.77% increase) and $33.40 for non-QPs (a 3.26% increase). This is the first payment increase for physicians in five years. (Rates in 2025 were $32.35 for both QPs and non-QPs.)

RHCs are typically reimbursed by Medicare under the All-Inclusive Rate (AIR) and not the PFS for most services. The AIR isn’t changing. Services, like care management, telehealth, and preventive services, though, are reimbursed using PFS rates. RHCs, and there will now be higher reimbursements for these services, whether or not clinicians are APM participants.

CMS also changed the geographic practice cost indices (GPCIs) and malpractice relative value units (RVUs) that may result in Medicare payments going up or down depending on your location and specialty.

Payment Rate Adjustments 

CMS is changing how it determines payment rates for physician services. For most non-time-based procedures, it will apply an “efficiency adjustment” for efficiency gains over time based on the Medicare Economic Index (MEI) productivity adjustment percentage. 

There will be a 2.5% reduction in Medicare reimbursements for all but time-based services. CMS doesn’t expect more than a 1% change in total relative value units (RVUs). Still, services commonly done in rural areas — such as imaging or routine procedures — may see a higher impact as may smaller rural patient volumes that make efficiency gains harder to achieve. There may also be more scrutiny of how services are valued and lower payments for some procedures.

As of October 31,CMS was finalizing the list of HCPCS codes that will be exempt from the adjustments. 

Practice Expense Changes

In 2026, CMS is finalizing updates to its practice expense (PE) methodology, such as recognizing higher indirect costs for office-based compared to facility-based practitioners. It’s also finalizing a plan to use hospital data, for example data from the Medicare Hospital Outpatient Prospective Payment System (OPPS), to set rates for some services paid under the PFS, like radiation therapy and some remote patient monitoring.

This will change how Medicare payments are calculated for indirect practice expenses for in-office versus facility services.

• Independent, office-based practices may see higher compensation for overhead.
• Hospitals may see lower reimbursements for the same services. 

Overall using hospital data should lead to payments that are better aligned with real-world costs. 54

Telehealth Service Changes

CMS is simplifying how Medicare Telehealth Services List items are reviewed and added. It’s also eliminating the difference between provisional and permanent telehealth services. It is eliminating HCPCS code G0136 and adding codes:

• 90849 (multiple family group psytx)
• G0473 (group behavioral counseling 2–10)
• G0545 (infectious disease add-on)
• G0545 (inherent visit to inpt)
• 92622 and 92623 (diagnostic analysis, programming and verification of an auditory osseointegrated sound processor)

Frequency limits for telehealth inpatient visits, nursing facility visits, and critical care consultations are being eliminated (HCPCS codes 99231–99233, 99307–99310, and G0508 and G0509). 

Updates will make using real-time two-way audio-video technology (not audio-only) for direct supervision of some services permanent and let virtual supervision be used for all but some surgical procedures (010 and 090). Services where indirect supervision can be used include diagnostic tests (42 CFR 410.32), pulmonary rehab (42 CFR 410.47), and cardiac rehabilitation and intensive cardiac rehab (42 CFR 410.49). In rural areas, the ability for providers to supervise residents virtually is extended.

CMS will also finalize letting teaching physicians be virtual presence in teaching settings in clinical instances when a service is permanently offered virtually.

These changes expand access and improve outcomes, especially for rural areas, while giving providers more flexibility and fewer restrictions for telehealth services. They also make scheduling and staffing more efficient. 

Improved Care for Chronic Illness and Behavioral Health Needs

Changes include making chronic disease prevention and management a national priority and integrating behavior health into primary care. This includes new optional add-on billing codes to support behavioral health integration (BHI) and psychiatric collaborative care as part of advanced primary care management (APCM). 

HCPCS code G0511 (general care management) sunsetted September 30, 2025. And in 2026, RHCs and FQHCs will bill individual CPT/HCPCS codes for CCM, APCM, behavioral health integration, and remote monitoring:

• G0556 for patients with zero to one chronic conditions
• G0557 for patients with two or more chronic conditions
• G0558 for qualified Medicare beneficiaries with two or more chronic conditions

CMS also expanded payment for digital mental health treatment (DMHT) devices used to treat attention deficit hyperactivity disorder (ADHD). It may in the future expand payments to other devices as well.

These updates give providers and practices more revenue streams. They also make it easier to incorporate technology into treatment plans.