Original Medicare telehealth services must be submitted in accordance with applicable CMS guidance for the date of service; Humana MA plans allow such services consistent with CMS guidance and will deny charges that do not satisfy CMS billing guidance (including appropriate POS code or modifier).
Congressionally-authorized coverage-related waivers have been applied to Original Medicare telehealth services and expire December 31, 2027; CMS limitations will be applied beginning January 1, 2028 unless the service qualifies under the additional telehealth services benefit.
ALL of the following
The service is included in the member's Evidence of Coverage under the additional telehealth benefit.
The service is provided by a physician or qualified healthcare practitioner with a valid contract with Humana who has satisfied Humana's telehealth credentialing and recredentialing standards.
The practitioner meets all applicable licensure, certification and registration requirements (including DEA registration, if applicable) for the state(s) where they practice and the state where the patient is located, is operating within scope of license, and meets professional practice standards in those states.
The service is delivered using real-time interactive audio technology (real-time interactive video is encouraged) and the technology used must permit provision of all necessary components of the billed code.
The practitioner verifies the member's identity before providing the service.
The member provides verbal or written consent to receive the service, in accordance with state law.
The member is present for the full duration of the service.
Place-of-service and modifier reporting rules: For services beginning January 1, 2024 providers must report POS 02, POS 10, or an applicable hospital POS with modifier 93 or 95 when the patient is at home and the practitioner is in a hospital; note that temporary POS guidance applied for the period beginning May 12, 2023 through December 31, 2023.
Audio-only services must be identified with modifier 93 when billed, per Humana requirements for telehealth reporting.
Other virtual services covered by Original Medicare (for example, e-visits, virtual check-ins, remote monitoring) must be submitted according to applicable CMS guidance; Humana MA plans follow CMS guidance and will deny charges that do not comply.
FQHCs and RHCs: follow CMS-specific reporting rules—mental health telehealth reported with applicable HCPCS II or CPT codes, non-mental health telehealth with G2025, and virtual services reported with G0071 through 12/31/2025; beginning 1/1/2026 report the same codes as professional providers. Append modifier 95 for Original Medicare telehealth or additional telehealth services as applicable.
Humana Medicaid plans allow telehealth consistent with federal law and state Medicaid agency requirements; claims remain subject to plan requirements including medical necessity, reasonableness, and any applicable referral or authorization rules.