CMS Mandates Telehealth Billing Change for FQHCs/RHCs and Launches ACCESS Model for Chronic Care

What this means for your practice

This dual announcement from CMS presents significant regulatory developments for healthcare providers, particularly those leveraging telehealth and technology-supported care. For FQHCs and RHCs, the mandate to cease using code G2025 and transition to specific service codes for non-behavioral telehealth distant-site services requires immediate attention for billing system updates and staff training to ensure compliance by October 2026. For a broader range of telehealth brands and healthcare businesses, the ACCESS Model signals CMS's strategic shift towards value-based, outcome-aligned payment structures for chronic disease management. While voluntary, the model’s emphasis on technology-supported care delivered virtually, asynchronously, or through devices indicates a pathway for future Medicare payment innovation. Practices capable of demonstrating measurable health outcomes for conditions like hypertension, diabetes, or depression, and willing to invest in robust technology and care coordination, may find ACCESS a viable avenue for growth and sustainable reimbursement. It also underscores the increasing regulatory scrutiny on the efficacy and accountability of technology-enabled care.

Washington D.C. – The Centers for Medicare & Medicaid Services (CMS) has announced a significant billing change affecting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for telehealth services, alongside the introduction of a new, voluntary payment model aimed at advancing technology-supported chronic care.

Mandatory Telehealth Billing Update for FQHCs and RHCs

Effective October 1, 2026, FQHCs and RHCs will be required to modify their billing practices for distant-site non-behavioral telehealth services. These facilities must cease the use of current procedural terminology (CPT) code G2025 for such services. Instead, FQHCs and RHCs will be mandated to bill specific service codes, complemented by appropriate modifiers, to ensure accurate reimbursement for the telehealth care provided.

This change signifies a refinement in how Medicare pays for telehealth delivered by these critical community providers, aiming for greater specificity in billing to reflect the actual services rendered rather than a generic telehealth code.

Introducing the ACCESS Model: Advancing Chronic Care with Effective, Scalable Solutions

CMS is also launching the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a comprehensive 10-year initiative designed to expand access to new technology-supported care options for Medicare beneficiaries managing chronic health conditions. This voluntary model seeks to address existing Medicare payment barriers that have limited the availability of innovative care services.

The Problem and the Solution

Currently, individuals with Original Medicare face limited access to technology-supported care services for chronic condition management due to prevailing Medicare payment methodologies. The traditional fee-for-service approach often pays for a defined set of activities that do not align with the integrated and continuous nature of technology-supported care.

The ACCESS Model offers a solution by testing a new payment option that prioritizes outcomes over activities. This approach enables clinicians to deliver innovative technology-supported care that is designed to improve patients' health and effectively complement traditional in-person care.

Key Focus and Conditions

The model specifically targets chronic conditions affecting a significant portion of the Medicare population, including:

• High blood pressure
• Diabetes
• Chronic musculoskeletal pain
• Depression

By focusing on these prevalent conditions, ACCESS aims to empower patients to achieve their health goals and provide clinicians with greater flexibility in delivering modern, technology-enabled care.

Outcome-Aligned Payments (OAPs)

The core innovation of the ACCESS Model is the implementation of Outcome-Aligned Payments (OAPs). Participating Medicare-enrolled care organizations will receive recurring payments for managing patients' qualifying chronic conditions. Full payment will be contingent upon achieving measurable health outcomes, such as a patient with hypertension lowering their blood pressure by a specified margin (e.g., 15 mmHg).

This outcome-focused payment structure rewards clinical improvement and condition control based on each person’s starting point, moving away from volume-based reimbursement.

Model Design and Participation Requirements

ACCESS care organizations are expected to offer integrated, technology-supported care that may include a diverse range of services:

• Clinician consultations
• Lifestyle and behavioral support (e.g., nutrition, exercise, smoking cessation)
• Therapy and counseling
• Patient education and care coordination
• Medication management
• Ordering and interpreting diagnostic tests and imaging
• Use or monitoring of Food and Drug Administration (FDA)-authorized devices (including software or devices subject to FDA enforcement discretion)

Care delivery within the model is flexible, allowing for services to be provided in-person, virtually, asynchronously, or through other technology-enabled methods as clinically appropriate.

To ensure safe and effective care, participating organizations must:

• Enroll in Medicare Part B as providers or suppliers.
• Comply with applicable state licensure requirements.
• Adhere to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and FDA requirements (or operate under FDA enforcement discretion).
• Designate a physician Clinical Director responsible for clinical oversight and compliance.

The ACCESS Model will run for 10 years, beginning July 5, 2026, with rolling start dates for participants on August 17, 2026, and October 1, 2026. CMS plans to monitor clinical performance and publicly report risk-adjusted health outcomes to promote transparency.

Key Facts

| Detail | Value | |---|---| | FQHC/RHC Billing Change Effective Date | October 1, 2026 | | ACCESS Model Start Date | July 5, 2026 | | ACCESS Participant Rolling Start Dates | August 17, 2026 and October 1, 2026 | | Model Duration | 10 years | | Affected Providers (Billing Change) | Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) | | Payment Mechanism (ACCESS Model) | Outcome-Aligned Payments (OAPs) |

Frequently Asked Questions

What specific telehealth billing change must FQHCs and RHCs implement?

Effective October 1, 2026, FQHCs and RHCs must stop using code G2025 for distant-site non-behavioral telehealth and instead bill specific service codes with appropriate modifiers.

What is the primary goal of the new ACCESS Model?

The ACCESS Model aims to expand access to new technology-supported care options for managing chronic conditions for people with Medicare by testing an outcome-aligned payment approach.

What types of conditions does the ACCESS Model focus on?

The model focuses on common chronic conditions such as high blood pressure, diabetes, chronic musculoskeletal pain, and depression.

How does the ACCESS Model change Medicare payment for chronic care?

Instead of paying for a defined set of activities (fee-for-service), ACCESS will test Outcome-Aligned Payments (OAPs) where participating organizations receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes.

What are the requirements for healthcare organizations to participate in the ACCESS Model?

Participating organizations must enroll in Medicare Part B as providers or suppliers, comply with state licensure, HIPAA, and FDA requirements, and designate a physician Clinical Director responsible for clinical oversight and compliance.

Source: cms.gov — CMS Mandates Telehealth Billing Change for FQHCs and RHCs Starting October 2026