US · guidance
CMS Pub. 100-02, ch. 13, § 80.3
RHC and FQHC Cost Report Forms
RHCs and FQHCs use one of the following cost report
forms: RHCs:
RHCs: Form CMS-222-17, Independent Rural Health Clinic Cost Report.
Hospital-based RHCs: Worksheet M of Form CMS-2552-10, Hospital and
Hospital Care Complex Cost Report.
FQHCs:
FQHCs: Form CMS-224-14, Federally Qualified Health Center Cost Report.
Information on these cost report forms is found in Chapters 44, 46, and 40, of the
“Provider Reimbursement Manual - Part 2” (Publication 15-2), which can be located
on the CMS Website at http://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Paper-Based-Manuals.html.
History
(Rev. 12832; Issued: 09-12-24; Effective:01-01-24; Implementation:10-14-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3b93aa624ee8eeded0614a9c000662d9c21c8a242342d10e2739e0e6ce30f453
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