Currentmagellan_healthcarePolicy N/A

2026 Telehealth Payable Services - Medicare

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Lists Medicare telehealth-payable CPT/HCPCS codes and indicates whether telehealth delivery and audio-only delivery are permitted for each service; intended for providers and billing staff submitting claims to Magellan Healthcare.

Policy Summary

Payermagellan_healthcare

Policy2026 Telehealth Payable Services - Medicare

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReview listed CPT/HCPCS codes for telehealth and audio-only permissibility; follow Magellan claims submission rules for Medicare telehealth payable services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100+CPT/HCPCS codes listed

2026 alignedCMS telehealth column present

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Currentmagellan_healthcarePolicy N/A

2026 Telehealth Payable Services - Medicare

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Policy Summary

Payermagellan_healthcare

Policy2026 Telehealth Payable Services - Medicare

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReview listed CPT/HCPCS codes for telehealth and audio-only permissibility; follow Magellan claims submission rules for Medicare telehealth payable services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100+CPT/HCPCS codes listed

2026 alignedCMS telehealth column present

Telehealth Coverage Criteria & Notes

Coverage criteria and notes

Coverage stance by service line and code-level permissions:

Behavioral health psychotherapy, diagnostic, and crisis codes are payable via telehealth when listed; many of these CPT codes explicitly permit audio-only delivery as indicated (examples: 90785, 90791, 90792, 90832, 90834, 90837, 90839).

General E/M, facility, and consult HCPCS/G-codes are listed with a CMS permissibility column for 2026; many inpatient, hospital, ED, and facility consult codes appear as telehealth-payable per Magellan but have '2026 CMS Telehealth' and audio-only columns that must be verified per code when billing (see per-code table).

Autism Specialty Product exception: Autism Specialty Product services are excluded from member benefits unless the member’s plan includes Autism Specialty Product coverage; codes and telehealth/audio-only permissibility are listed in the Autism specialty section and may show 'No' for audio-only for many codes.

OTP specialty rules: Opioid Treatment Program (OTP) services and related weekly counseling G-codes are included; OTP HCPCS codes such as +G2076 and +G2077 are listed as telehealth-payable and audio-only permitted, and CMS permits audio-only telephone calls for therapy/counseling portions of specified weekly G-codes—verify per-code details when billing.

FQHC mental health visit codes (G0469, G0470) are included as telehealth-payable and are indicated as permitting audio-only delivery ('Yes' for audio-only in the table).

CPT / HCPCS Codes and CMS Telehealth Status

Behavioral health telehealth codesCPTCovered

90785	Interactive complexity (audio-only permitted)
90791	Psychiatric diagnostic evaluation - no medical services (audio-only permitted)
90792	Psychiatric diagnostic evaluation - with medical services (audio-only permitted)
90832	Psychotherapy 30 minutes (audio-only permitted)
90834	Psychotherapy 45 minutes (audio-only permitted)
90837	Psychotherapy 60 minutes (audio-only permitted)
90839	Psychotherapy for crisis, initial 60 minutes (audio-only permitted)
90840	Psychotherapy for crisis, additional 30 minutes (audio-only permitted)

Medicare telehealth HCPCS/G-codesHCPCSCovered

G0425	Telehealth consult, initial inpatient or emergency department, per 30 minutes
G0459	Inpatient telehealth, pharmacological management
G2211	Visit complexity inherent to E/M associated with medical care services

inv-04: Telehealth CMS permissibility column

Per-code CMS telehealth permissibility (2026)Each listed CPT/HCPCS code includes a '2026 CMS Telehealth' column indicating CMS permissibility for telehealth in 2026 (values shown as Yes/No).

Example - G0425G0425 (Telehealth consult, initial inpatient or emergency department, per 30 minutes) — 2026 CMS Telehealth: Yes/No as shown in table

Example - G0426/G0427G0426 (50 minutes) and G0427 (70 minutes) — 2026 CMS Telehealth: Yes/No as shown in table

Example - G0459G0459 (Inpatient telehealth, pharmacological management) — 2026 CMS Telehealth: Yes/No as shown in table

Prolonged service example - +G0318+G0318 (Prolonged home or residence service, each 15 minutes) — 2026 CMS Telehealth: Yes

Billing, Claims & Provider Responsibilities

Billing Rule

Billing/claims check — verify code-level telehealth and audio-only permissions

Review the Magellan list of CPT/HCPCS codes before submitting Medicare telehealth claims to ensure telehealth and audio-only delivery permissions are met and follow Magellan claims submission rules for Medicare telehealth payable services.

Verify per-code CMS telehealth permissibility (2026 CMS Telehealth column) before billing (see per-code entries such as +G0318, G0406–G0408, G0425–G0427, G0459).
Confirm audio-only permissibility using the Audio-only column (e.g., many listed codes are marked 'No' for audio-only; submit only when audio-only is permitted).
Use Magellan claims submission rules for Medicare telehealth payable services when submitting the claim.

Definitions and Delivery Mode Notes

inv-06: Audio-only permissibility

Audio-only permissibility indicated per codeEach CPT/HCPCS entry includes an 'Audio-only, permitted?' column that specifies whether audio-only delivery is permitted (values shown as Yes/No).

Example - +G0318+G0318 — Audio-only permitted: No

Example - G0425/G0426/G0427G0425, G0426, G0427 — Audio-only permitted: No

Example - G0459G0459 — Audio-only permitted: (blank/unspecified) as presented in source table

inv-07: 2026 CMS Telehealth definition

Definition of '2026 CMS Telehealth' columnIndicates whether CMS permits the listed CPT/HCPCS code to be provided via telehealth in 2026 (values shown as Yes/No in the table).