Medicare Advantage
Advanced Search

Telehealth Services
MA00.036n
​

Policy

This policy does not describe telehealth services that are provided by a telemedicine vendor.

​TELEHEALTH SERVICES ​COVERED IN ALIGNMENT WITH​ ORIGINAL MEDICARE

AUDIO AND VIDEO TELECOMMUNICATIONS
Services identified by procedure codes on attachment A performed through telehealth are covered for new and established patients when the encounter takes place via an interactive audio and video telecommunications system that permits synchronous (i.e., real-time) encounters among the professional provider at a distant site and the individual at the originating site communications.

AUDIO ONLY TELECOMMUNICATIONS
Services identified by procedure codes on attachment A performed through audio-​only telecommunications are covered for established patients when either of the following criteria are met:
  • ​Encounters for the treatment, diagnosis, and evaluation for physical health through audio-only communications for established patients are covered if the individual does not have the technical capacity, does not have the availability of real-time audio and visual interactive telecommunications, or does not provide consent to the use of real-time video technology.  
  • ​Encounters for the treatment, diagnosis, and evaluation for behavioral health or substance use dis​order through audio-only communications for established patients are covered when the individual is located in their home.

VIRTUAL CHECK-IN CRITERIA
Virtual check-ins (e.g., phone or video chat) with the individual's provider for 5 to 10 minutes​ is covered when all of the following criteria are met:

  • The individual is an established patient
  • The check-in is not related to an office visit in the past 7 days
  • The virtual check-in does not lead to an office visit within 24 hours of the soonest available appointment​
E-VISIT CRITERIA
E-visits, an asynchronous communication through a patient portal, when an established patient initiates the inquiry are covered when all of the following criteria are met:
  • The e-visit is not related to an office visit in the past 7 days
  • The e-visit does not lead to an office visit within 24 hours of the soonest available appointment​

ADDITIONAL TELEHEALTH SERVICES COVERED BY THE MEDICARE ADVANTAGE PLANS
Additional telehealth services (e.g., Medicare Diabetes Prevention program, cardiac rehabilitation, pulmonary rehabilitation) reported via one of the procedure codes on attachment B ​are covered when performed by network providers.


NOT ELIGIBLE FOR REIMBURSEMENT
In addition to the procedure codes identified in the coding table as not eligible for separate reimbursement​​, the following are not eligible for reimbursement consideration: ​
  • Triage to assess the appropriate place of service
  • Administrative matters, including but not limited to, scheduling, registration, updating billing information, reminders, requests for medication refills or referrals, ordering of diagnostic studies, and medical history intake completed by the patient
  • Any CPT or HCPCS code that is not listed in the eligible code section of this policy, attachment A, or attachment B if billed with modifier 93, 95, GT, or FQ or place of service 02 or 10
  • The originating site of service fee or facility fee
  • Any equipment used for telemedicine communications
  • Communications​​​ including, but not limited to, reporting of test results and provision of educational materials are incidental to E/M services, counseling, or physical health services included in this policy​​
REIMBURSEMENT
When the eligible physical health services are performed through telehealth by a participating professional provider, reimbursement for the physical health service will be at 85 percent of the provider allowance, subject to the specific terms and conditions of the participation agreement. 

Note: This does not apply to behavioral health services when performed through telehealth by a participating behavioral health provider

REQUIRED DOCUMENTATION
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS
Professional providers performing telehealth services described in this policy must report the appropriate ​modifier (93, 95, GT, or FQ​) and appropriate place-of-service (POS) code 02 ​or 10 to ensure payment of eligible telehealth services.

Inclusion of a code in this policy does not guarantee reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Guidelines

This policy is consistent with Medicare’s coverage determination. The Company’s reimbursement methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, telehealth services​ are covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.

Description

Telehealth can be defined as the exchange of medical information between an individual and professional provider from one site to another via a secure telecommunications system for which there is a reasonable level of certainty in establishing a diagnosis and generating a treatment plan.

Telehealth is often employed to provide healthcare services to rural, remote, and underserved communities that have limited access to medical specialists and professional providers. Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information ac​ross distance.

Telehealth includes the delivery of remote healthcare via a growing variety of secure applications of telecommunication systems including video, smart phones, and wireless tools that allow for both audio and video transmission, permitting two-way contact that is interactive and real-time (i.e., synchronous) between an individual and a professional provider. Asynchronous or store and forward is the transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous applications would not be considered telehealth.

Telehealth is used to support healthcare when the professional provider and the individual are physically separated. A telehealth service includes both a distant site and an originating site. A distant site is the site at which the professional provider is delivering the service at the time the service is provided via telecommunications system. An originating site is the location of an individual at the time the service furnished via a telecommunication system occurs.

References

American Academy of Family Physicians. Primary care. [AAFP Web site]. 2022. Available at: http://www.aafp.org/about/policies/all/primary-care.html. Accessed March 04, 2026.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System Pub 100-04 Medicare Claims Processing, Transmittal 3586 Jan 2017. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R3586CP.pdf. Accessed March 04, 2026.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System. Pub. 100-04: Medicare Claims Processing. Transmittal 1026. Medicare telehealth services.[CMS Web site]. 01/01/2007. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1026cp.pdf. Accessed March 04, 2026.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System. Pub 100-04 Medicare Claims Processing. Transmittal 1423. [CMS Web site]. 01/01/2​008. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1423CP.pdf. Accessed March 04, 2026.

Centers for Medicare & Medicaid Services (CMS). CMS Manua​l System. Pub. 100-04: Medicare Claims Processing. Transmittal 2161. Incentive Payment Program for Primary Care Services, Section 5501(a) of the Affordable Care Act. [CMS Web site]. 01/01/2011. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2161CP.pdf. Accessed March 04, 2026.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System.Pub. 100-04: Medicare Claims Processing. Transmittal 3157: Telehealth origination site facility fee payment amount update. [CMS Web site]. 12/24/2014. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2014-Transmittals-Items/R3157CP.html. Accessed March 04, 2026​​​.

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 12 Section 190[CMS Web site]. 12/19/2024. Available at: http://www.cms.gov/manuals/downloads/clm104c12.pdf. Accessed March 04, 2026​​​​​.​

Centers for Medicare & Medicaid Services (CMS). Medicare Program: CY 2018 Updates to the Quality Payment Program and Quality Payment Program: Extreme and Uncontrollable Circumstance Policy for the Transition Year. 01/01/2018. Available at: https://www.federalregister.gov/documents/2017/11/16/2017-24067/medicare-program-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme. Accessed March 04, 2026​.

Centers for Medicare & Medicaid Services (CMS). Telehealth. [CMS Web site]. 02/05/2025. Available at: http://cms.gov/Medicare/Medicare-General-Information/Telehealth/. Accessed March 04, 2026​.

Federation of State Medical Boards. Model policy for the telemedicine technologies in the practice of medicine. [FSMB Web site]. April 2014. Available at: https://www.kff.org/wp-content/uploads/sites/3/2014/10/fsmb_telemedicine_policy.pdf. Accessed March 04, 2026​​.​

Hewitt H, Gafaranga J, McKinstry B. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis. Br J Gen Pract. 2010;60(574):201-212.

Coding

CPT Procedure Code Number(s)
ELIGIBLE 

​E-VISITS
​
98970, 98971, 98972, 99421, 99422, 99423

ALTHOUGH ELIGIBLE FOR TELEHEALTH, THE FOLLOWING CODE IS NOT ELIGIBLE FOR REIMBURSEMENT

​VIRTUAL CHECK-IN 

98016​​
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)

ELIGIBLE 

​VIRTUAL CHECK-IN 

​G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion

G2252 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related EM service provided within the previous 7 days nor leading to an EM service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

​​NON-COVERED

Q3014 Telehealth originating site facility fee​

S0320 Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month

S5185 Medication reminder service, Misspelled Wordnonface-to-face; per month
Revenue Code Number(s)

ELIGIBLE

0551 Skilled Nursing- Visit Charge

0561 Home Health (HH) Medical Social Services - Visit Charge

0562 Home Health (HH) Medical Social Services -Hourly Charge

0590 Home Health (HH) Units of Misspelled WordSer​vice - General Classification

0651 Hospice Service - Routine Home Care

0652 Hospice Service - Continuous  Home care

0655 Hospice Service - Inpatient Respite Care

0656 Hospice Service - General Inpatient Care Misspelled WordNonrespite

​0905 Behavioral Health Treatments/Services (also see 091X, an extension of 090X) - Intensive Outpatient Services - Psychiatric

0906 Behavioral Health Treatments/Services (also see 091X, an extension of 090X) - Intensive Outpatient Services - Chemical Dependency

0912 Behavioral Health Treatments/Services Extension of 090X-Partial Hospitalization-Less Intensive

0913 Behavioral Health Treatments/Services Extension of 090X-Partial Hospitalization- Intensive

0943 Other Therapeutic Services (see also 095X, an extension of 094X)-Cardiac Rehabilitation

0948 Other Therapeutic Services (see also 095X, an extension of 094X)-Pulmonary Rehabilitation

Modifiers

COVERED

95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications system

FR The supervising practitioner was present through two-way, audio/video communication technology

G0 Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke

GT Via interactive audio and video telecommunications system

THE FOLLOWING MODIFIERS ARE APPLICABLE FOR BEHAVIORAL HEALTH SERVICES ONLY

93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System

FQ The service was furnished using audio-only communication technology

NON-COVERED

GQ Via Asynchronous telecommunications system

Coding and Billing Requirements

Policy History

​Revisions From MA00.036n:
​01/01/2026
​This version of the policy will be issued on 04/06/2026 with a retroactively effective date of 01/01/2026.

As previously communicated in the News Article issued 03/23/2026, the following codes have been added to Attachment A: TELEHEALTH SERVICES ​COVERED IN
ALIGNME​NT WITH​ ORIGINAL MEDICARE​:
  • G0545, G0473​, 92622, 92623
​The following code has been moved from Attachment B: ​ADDITIONAL SERVICES WHEN PERFORMED BY NETWORK PROVIDERS​ to Attachment A: TELEHEALTH SERVICES ​COVERED IN ALIGNMENT WITH​ ORIGINAL MEDICARE​:​
  • 90849
The policy language was updated to clarify services identified in the coding table as not eligible for separate reimbursement​​.​

​​​The coding table and Attachments were updated to clarify services not eligible for reimbursement.

Revisions From MA00.036m:
​01/01/2026
​Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.

This policy has been identified for the HCPCS code update, issued 04/01/2026 with a retroactive effective date of 01/01/2026.

The following HCPCS narrative has been revised in this policy: G2211​

Revisions From MA00.036l:
01/01/2026

Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.

This policy has been identified for the HCPCS code update, effective 01/01/2026.

The following HCPCS code​​ has been terminated and removed (no longer valid code) from this policy:​ G0071


The following HCPCS​ code has been added to this policy as eligible for reimbursement consideration on Attachment B​: G9871

 

The following HCPCS narratives have been revised in this policy: G0136


Revisions From MA00.036k:

01/01/2025

The Original Medicare section was updated to distinguish criteria for audio and video telecommunications and audio only telecommunications. The originating site requirements and the eligible distant site professional providers requirements were removed from the Original Medicare section. The criteria for the communications methods section of the Original CMS section to clarify when physical health and behavioral health and substance use disorder services are allowed to be performed through an audio-only method. The coding section was updated to indicate the procedure codes that are in alignment with Original Medicare and Additional Telehealth Services covered by Medicare Advantage Plans.


The following codes were added to the policy: 96202, 96203, 97550, 97551, 97552, G0539, G0540, G0541, G0542, G0543, G0011, G0013, G0560


Revisions From MA00.036j :
01/01/2025
Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.


This policy has been identified for the CPT code update, effective 01/01/2025.

The following CPT  codes have been termed (no longer valid code) from this policy:: 99441, 99442, 99443      

 

The following CPT code has  been added to this policy as not eligible for reimbursement:

98016

 

The following CPT narratives have been revised in this policy: 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972

 

This policy has been identified for the HCPCS code update, effective 01/01/2025.

The following HCPCS code has been termed (no longer valid code) from this policy: G2012 


Revisions From MA00.036i :
01/02/2024
The following codes were added to the policy under physical health and behavioral health:

0591T, 0592T, 0593T, 98966, 98967, 98968, 99441, 99442, 99443, G0136

​The following CPT narratives have been revised in this policy:

99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99306, 99308, G0410​

Revisions From MA00.036h:
​01/01/2024

​Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.​
06/01/2023This version of the policy will become effective 06/01/2023.​ The following criteria have been updated to address the following for Telehealth services:​
  • ​Home was added as an eligible originating site.
  • Physical therapist, occupational therapist, speech language pathologist, audiologist were added as eligible providers.
  • In-person visit requirements for behavioral health disorders have been added to the criteria
  • Criteria for virtual check-in, e-visits, and additional telehealth coverage was added to the policy
  • Criteria for audio-only communications was added to the policy
  • A change in provider reimbursement for certain services delivered through telemedicine.
  • Criteria for not eligible for reimbursement was updated.
  • As previously communicated through an article, the following codes were added to the policy as eligible to be performed through telemedicine:
    • ​Procedure Codes - 0362T, 0373T, 774​27, 90875, 90901, 90849, 90853, 90953, 90956, 90959, 90962, 92002, 92004, 92012, 92014, 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92550, 92552, 92553, 92555, 92556, 92557, 92563, 92565, 92567, 92568, 92570, 92587, 92588, 92601, 92602, 92603, 92604, 92607, 92608, 92609, 92610, 92625, 92626, 92627, 93750, 93797, 93798, 94002, 94003, 94004, 94005, 94625, 94626, 94664, 95970, 95971, 95972, 95983, 95984, 96105, 96110, 96112, 96113, 96121, 96125, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 97110, 97112, 97116, 97129, 97130, 97150, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97763, 98960, 98961, 98962, 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99291, 99292, 99304, 99305, 99306, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99417, 99418, 99468, 99469, 99471, 99472, 99473, 99475, 99476, 99477, 99478, 99479, 99480, 99483, 99495, 99496, 99497, 99498, G0071, G0153, G0161, G0316, G0317, G0318, G0410, G0422, G0423, G2010, G2012, G2025, G2211, G2212, G2250, G2251, G2252, G3002, G3003, G9685, G9873, G9874, G9875, G9876, G9877, G9878, G9879, G9880, G9881, G9882, G9883, G9884, G9885, G9890, G9891, H0015, H0035, S0201, S9083, S9128, S9152, S9472, S9473, S9480​

      Modifiers - 93, FQ, FR

      Revenue Codes - 0561, 0562, 0551, 0590, 0905, 0906, 0912, 0913, 0651, 0652, 0655, 0656, 0943, 0948

  • ​Modifiers 93, FQ, and FR and Place of Service 10 was added to the billing requirements.

Revisions From MA00.036g:
04/01/2020This policy has been identified for the HCPCS code update, effective 04/01/2020.

The following HCPCS narratives have been revised in this policy: G2061 G2062 G2063

Revisions From MA00.036f:
01/01/2020
    The following CPT codes have been termed from this policy:
    96150, 96151, 96152, 96153, 96154, 98969, 99444

    The following CPT and / HCPCS codes have been added to this policy: 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171, G2061, G2062, G2063, 98970, 98971, 98972, 99421, 99422, 99423, G2086, G2087, G2088

Revisions From MA00.036e:
12/16/2019
    This version of the policy will become effective 12/16/2019. This policy has been updated to remove the requirement for modifier GT and add a requirement of Place of Service code 02.

    The following codes were added to the policy:


    90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 96116, 96150, 96151, 96152, 96153, 96154, 96160, 96161, 97802, 97803, 97804, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99231, 99232, 99233, 99307, 99308, 99309, 99310, 99354, 99355, 99356, 99357, 99406, 99407, 99495, 99496, 99497, 99498, G0108, G0109, G0270, G0296, G0396, G0397, G0420, G0421, G0438, G0439, G0442, G0443, G0444, G0445, G0446, G0447, G0459, G0506, G0513, G0514

    The following codes were removed from the policy, which was communicated via a Newsflash. The Newsflash indicated the changed position of the codes to not eligible for separate reimbursement:


    99446, 99447, 99448, 99449, 99451, 99452, G0459


Revisions From MA00.036d:
01/01/2019The following CPT codes have been termed from this policy: 0188T, 0189T.

The following CPT codes have been added to this policy: 99451, 99452

The following modifier has been added to the policy: G0

Revisions From MA00.036c:
01/01/2018This policy has undergone a routine review and the medical necessity criteria have been revised to include dermatology and ophthalmology as specialties allowed for asynchronous telehealth.

Revisions From MA00.036b:
06/07/2017This policy has been reissued in accordance with the Company's annual review process.
01/01/2017This version of the policy will become effective 01/01/2017.

The following HCPCS codes have been added to this policy:

G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth

G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth

Revisions From MA00.036a:
05/04/2016This version of the policy will become effective 05/04/2016.

The following criteria have been added to this policy:
  • Certified Registered Nurse Anesthetists added to distant site professional providers
  • Non-covered statement added for when criteria not met for remote patient management, telemedicine services.
  • Required documentation

Clarification language has been added for claims submitted for telemedicine services with the telemedicine modifier:
  • GT Via interactive audio and video telecommunications system modifier

Revisions From MA00.036:
02/04/2015The policy has been reviewed and reissued to communicate the Company’s continuing position on Remote Patient Management: Telemedicine and Telehealt​h
01/01/2015This is a new policy.
1/1/2026
4/6/2026
MA00.036
Claim Payment Policy Bulletin
Medicare Advantage
{"7372": {"Id":7372,"MPAttachmentLetter":"B","Title":"ADDITIONAL SERVICES WHEN PERFORMED BY NETWORK PROVIDERS","MPPolicyAttachmentInternalSourceId":10389,"PolicyAttachmentPageName":"33725f9b-8b2e-4eed-a030-14a1255f1d88"},"7373": {"Id":7373,"MPAttachmentLetter":"A","Title":"TELEHEALTH SERVICES ​COVERED IN ALIGNMENT WITH​ ORIGINAL MEDICARE","MPPolicyAttachmentInternalSourceId":10390,"PolicyAttachmentPageName":"558e2cb2-9675-4683-a269-b41678a89034"},}
No
Connect with Us

2026 Independence Blue Cross

Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.