A Rural Health Roadmap Series Blog Entry
January 4, 2026
The financial landscape for Rural Health Clinics (RHCs) has shifted.1 As we enter 2026, the transition from bundled "G-codes" to a granular, service-specific model for care management is complete. For RHC administrators nationwide, and in our onsite focus areas in Arkansas, Mississippi, Alabama, Louisiana, Oklahoma, and East Texas, these updates represent a vital opportunity to align clinic revenue with the actual intensity of care provided.
Effective January 1, 2026, the statutory payment limit for independent RHCs and provider-based RHCs (in hospitals with 50+ beds) has increased to $165.00 per visit
Maximizing your reimbursement requires your cost-per-visit to meet or exceed the $165.00 cap. Under-reporting allowable costs—such as EHR technology, medical supplies, and non-provider clinical staff time—artificially lowers your AIR.
Regional Note: Clinics in the Palmetto GBA (Alabama) and Novitas Solutions (AR, LA, MS, OK, TX) jurisdictions should pay close attention to the 2026 Wage Index reclassifications. In states like Alabama, where the rural wage index has historically been lower (0.64), new legislative efforts are aiming to close the reimbursement gap to prevent further clinic closures (Source: Alabama Daily News, 2026).
The most significant operational shift for 2026 is the Dissolution of G0511. RHCs now bill specific CPT codes for services, enabling reimbursement that reflects the actual staff time and complexity.
New for 2025 and refined in the 2026 CMS Physician Fee Schedule (PFS), APCM codes allow RHCs to bill based on patient complexity rather than strict minute-tracking
Starting in 2026, RHCs can bill optional add-on codes (GPCM1, GPCM2, GPCM3) for BHI and Psychiatric CoCM in the same month as APCM.7 This allows for a truly integrated care model without the "double-counting" billing risks of previous years.
Telehealth flexibilities have been extended through December 31, 2026.
Learn more about how Oasis Medical Solutions and Azalea Health provide a stable, all-in-one solution for Rural Health Clinics, or contact us today for a consultation.
In a capped environment, claim hygiene is paramount. Avoid these three common pitfalls in the Southeast region:
This is a critical time for RHC leaders to be proactive. We recommend contacting your state's Department of Health or Rural Health Office to learn about the specific initiatives they have proposed and how your clinic can be involved in allocating these funds.
No. CMS considers these services duplicative. Most clinics find the APCM model (G0557) more lucrative for high-complexity patients in rural areas.
It applies to Independent RHCs and those provider-based to hospitals with 50+ beds. Small hospital-based RHCs (under 50 beds) established before 2021 remain under a different MEI-adjusted limit.
Oasis Medical Solutions is a trusted partner for healthcare practices, offering comprehensive services and support for Azalea Health's suite of electronic health record (EHR) and practice management solutions. Focusing on personalized implementation, training, and ongoing support, Oasis Medical Solutions helps clients optimize their technology to improve efficiency and deliver exceptional patient care.
Oasis Medical Solutions is a healthcare technology company that helps medical practices streamline their operations and maximize revenue. We specialize in providing Electronic Health Records (EHR) systems and related services, including practice management software, billing solutions, and consulting.
With a focus on personalized service and customized solutions, Oasis aims to empower healthcare providers to navigate the complexities of the healthcare industry and focus on delivering quality patient care.
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