Federally Qualified Health Centers (FQHCs) are entering a new era of value-based care. Two key changes are at the heart of this shift: the emergence of Advanced Primary Care Management (APCM) and the sunsetting of HCPCS code G0511 for care management services. As we move forward, FQHC leaders must be ready to adapt to and capitalize on these changes.
What is APCM?
APCM is a care delivery and payment model designed to align FQHC operations with the goals of comprehensive, coordinated, and value-driven healthcare. By focusing on holistic patient management, APCM promotes improved outcomes, better patient engagement, and sustainable financial models for health centers.
Under APCM, FQHCs are incentivized to deliver high-quality, proactive care through:
Patient-centered medical home (PCMH) principles
Enhanced care management and coordination
Performance-based payments tied to quality and outcomes
The End of G0511 – What’s Changing?
For years, FQHCs have used HCPCS code G0511 to bill for General Care Management services, including Chronic Care Management (CCM) and Behavioral Health Integration (BHI). G0511 provided a flat rate to cover a range of care management services, simplifying billing but sometimes limiting flexibility and precision.
Starting in July 2025, CMS will officially sunset G0511, replacing it with a requirement to report individual CPT and HCPCS codes for care management services. This change aims to:
Increase transparency by capturing the specific types of services delivered
Enable more accurate payment based on the scope and intensity of care
Encourage alignment with value-based payment models, particularly under APCM frameworks
Why This Matters for FQHC Leaders
These changes represent both a challenge and an opportunity:
Operational Readiness – FQHCs must prepare their billing, coding, and clinical documentation systems to accommodate individual codes for CCM and BHI services. Staff training and workflow redesign will be crucial.
Financial Optimization – While G0511 offered simplicity, the new structure allows for more granular billing, potentially increasing reimbursement if services are coded correctly and fully captured.
Strategic Alignment – APCM’s focus on proactive, coordinated care aligns with the shift away from bundled codes like G0511. FQHCs that embrace APCM will be better positioned for success in a value-based care environment.
Action Steps for FQHC Leaders
Here’s how your health center can stay ahead:
Assess Current Workflows: Identify gaps in your current care management coding and documentation processes.
Educate Your Teams: Ensure that care managers, billing staff, and providers understand the specific codes replacing G0511 and how to apply them correctly.
Leverage Technology: Update EHR and billing systems to support accurate, real-time reporting of care management services.
Explore APCM Participation: Consider how adopting or enhancing APCM can align your FQHC with future payment models and patient care expectations.
Monitor Financial Impact: Track changes in reimbursement and adjust strategies to maintain or increase revenue while improving patient outcomes.
Looking Ahead
The sunsetting of G0511 is not merely a regulatory shift – it’s a signal that FQHCs must move toward a more sophisticated, patient-centered approach to care management. APCM provides a roadmap for achieving this goal while maintaining financial stability.
As a leader, your proactive engagement with these changes will set the stage for your health center’s success in the evolving healthcare environment.
Position your organization for the next era of value-based care. Schedule a one-on-one strategy session.
