2025 Remote Care Reimbursement: What FQHCs & RHCs Need to Know

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) have long faced barriers in adopting value-based care—limited funding, staff shortages, and outdated billing structures. But that’s changing.

In 2024, CMS expanded coverage under code G0511 to include RPM, RTM, and PCM. Starting January 2025, CPT-based billing will replace G0511, offering higher reimbursement and allowing separate billing for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM). This shift aligns FQHC and RHC reimbursement more closely with fee-for-service models.

Why Remote Care Matters for FQHCs & RHCs

What Is RPM?

Remote Patient Monitoring (RPM) uses connected devices—like BP monitors or glucometers—to transmit vitals in real time to providers. This enables:

• Early intervention
• Fewer hospitalizations
• Better chronic disease management

What Is CCM?

Chronic Care Management (CCM) is care coordination for patients with 2+ chronic conditions. Services include:

• Personalized care plans
• Monthly check-ins
• Medication & lifestyle coaching

Together, RPM and CCM improve outcomes while reducing clinic burden.

Why RPM & CCM Are Being Widely Adopted

1. Better Health Outcomes

• RPM reduces ER visits by identifying risks early
• CCM ensures long-term adherence to care plans
  📊 A Louisiana FQHC saw a 24 mmHg drop in BP, 97 mg/dL glucose drop, and saved $302K annually

2. More Accessible Care

• Remote models reduce transportation and cost barriers
• Consistent care without frequent in-person visits

3. Stronger Revenue & Reimbursement

With CPT billing replacing G0511, you can now bill:

• RPM (CPT 99453, 99454, 99457, 99458)
• CCM (CPT 99490, 99439)
• Extension time codes for full-hour billing

4. Lower Staff Burden

• RPM automates monitoring
• CCM creates predictable patient engagement
• Outsourced teams (like Tellihealth’s) can reduce in-house workload

How RPM & CCM Work in Practice

Step 1: Identify Eligible Patients

• CCM: 2+ chronic conditions, seen in past 12 months
• RPM: 1+ chronic condition requiring vitals monitoring

Step 2: Deploy Devices & Educate

• RPM: Cellular or Bluetooth devices delivered to patients
• CCM: Nurse-led care plan development + monthly check-ins

Step 3: Continuous Monitoring

• RPM: Auto-transmission of vitals for review
• CCM: Ongoing engagement and care plan refinement

Step 4: Act on Alerts & Close Gaps

• RPM: Nurses flag abnormalities for provider intervention
• CCM: Address social determinants of health, follow-up care, and education

2025 Billing Codes Replacing G0511

RPM Codes

• 99453: One-time device setup
• 99454: Monthly transmission (16+ days)
• 99457: First 20 mins treatment management
• 99458: Additional 20 mins

CCM Codes

• 99490: First 20 mins of care management
• 99439: Additional 20 mins

Deadline: Switch to CPT billing by July 1, 2025

Building vs. Outsourcing Remote Care

DIY pitfalls:

• Choosing devices (Bluetooth vs. cellular)
• Managing high volumes of patient data securely
• Staff training for device setup and data review

With Tellihealth:

• End-to-end RPM & CCM service
• Cellular-enabled devices + EHR integration
• Trained care teams manage monitoring & outreach
• Secure data, compliant documentation, and audit support

Why Now Is the Time to Act

2025 CMS changes bring:

• Higher CPT reimbursements
• Separate billing for RPM + CCM
• Extension time codes = more revenue
• Reduced staff burnout via outsourcing

Final Takeaways:

• RPM + CCM offer clinical + financial benefits
• CPT billing creates sustainable models for FQHCs & RHCs
• Partnering with Tellihealth ensures smooth implementation

👉 Ready to launch or optimize your remote care program?
Contact Tellihealth to learn how our end-to-end RPM & CCM services support FQHCs and RHCs through the 2025 transition and beyond.