FHO+ Capitation Rates by Age and Sex (April 2026)
FHO+ pays an annualized capitation base rate by age band and sex, plus a monthly Comprehensive Care Management (CCM) payment.
Schedule 1 — Base payments
FHO Annualized Capitation Payment Rates by Age and Sex.
| Age band | Male | Female |
|---|---|---|
| 0 to 4 | $145.77 | $138.79 |
| 5 to 9 | $77.44 | $75.87 |
| 10 to 14 | $62.63 | $65.76 |
| 15 to 19 | $65.81 | $114.17 |
| 20 to 24 | $65.02 | $142.37 |
| 25 to 29 | $70.28 | $147.88 |
| 30 to 34 | $82.06 | $149.22 |
| 35 to 39 | $100.54 | $161.97 |
| 40 to 44 | $113.17 | $167.43 |
| 45 to 49 | $123.71 | $182.23 |
| 50 to 54 | $143.45 | $203.98 |
| 55 to 59 | $162.78 | $206.22 |
| 60 to 64 | $180.00 | $211.13 |
| 65 to 69 | $231.17 | $254.80 |
| 70 to 74 | $269.71 | $274.74 |
| 75 to 79 | $328.04 | $334.44 |
| 80 to 84 | $354.58 | $363.36 |
| 85 to 89 | $420.57 | $444.02 |
| 90+ | $524.65 | $557.61 |
Note: The value of the base rate payment shall be increased periodically as determined through the physician services agreement.
Comprehensive Care Management (CCM) payments
Monthly CCM Payment Rates by Age and Sex.
| Age band | Male | Female |
|---|---|---|
| 0 to 4 | $2.63 | $2.51 |
| 5 to 9 | $1.39 | $1.34 |
| 10 to 14 | $1.09 | $1.14 |
| 15 to 19 | $1.14 | $2.03 |
| 20 to 24 | $1.14 | $2.58 |
| 25 to 29 | $1.24 | $2.68 |
| 30 to 34 | $1.44 | $2.68 |
| 35 to 39 | $1.79 | $2.90 |
| 40 to 44 | $1.99 | $2.98 |
| 45 to 49 | $2.18 | $3.23 |
| 50 to 54 | $2.53 | $3.62 |
| 55 to 59 | $2.88 | $3.65 |
| 60 to 64 | $3.15 | $3.75 |
| 65 to 69 | $4.11 | $4.54 |
| 70 to 74 | $4.77 | $4.85 |
| 75 to 79 | $5.74 | $5.79 |
| 80 to 84 | $6.02 | $5.99 |
| 85 to 89 | $6.71 | $6.82 |
| 90+ | $7.56 | $7.71 |
APEX offers every physician or group a unique, transparent overview over their billing records.