Currentmagellan_healthcarePolicy N/A

2026 Telehealth Payable Services - Commercial

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Defines which CPT/HCPCS/AMA telehealth and related codes Magellan Healthcare considers payable for commercial lines in 2026, including whether audio-only delivery and CMS telehealth status apply; affects providers billing Magellan for telehealth services.

Policy Summary

Payermagellan_healthcare

Policy2026 Telehealth Payable Services - Commercial

Policy CodePolicy N/A

Change TypeNo material changes noted

Effective DateN/A

Next Review DateN/A

Key ActionUse this code-by-code payable services list to determine whether a telehealth service (including audio-only where noted) is payable before billing Magellan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100+listed CPT/HCPCS/telehealth-related codes and service lines

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Currentmagellan_healthcarePolicy N/A

2026 Telehealth Payable Services - Commercial

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Sign up for all magellan_healthcare policy alerts

Know when magellan_healthcare releases new policies or updates existing guidance.

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Policy Summary

Payermagellan_healthcare

Policy2026 Telehealth Payable Services - Commercial

Policy CodePolicy N/A

Change TypeNo material changes noted

Effective DateN/A

Next Review DateN/A

Key ActionUse this code-by-code payable services list to determine whether a telehealth service (including audio-only where noted) is payable before billing Magellan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100+listed CPT/HCPCS/telehealth-related codes and service lines

Manyservices marked as permitted for audio-only delivery

Yes/No per codeCMS telehealth flag present

Multipleservice settings listed

Telehealth Coverage Criteria

Per-code telehealth payable criteria

Per-service coverage determinations for telehealth payment are provided as a code list; many services are payable via telehealth and, where noted, audio-only delivery is permitted. CMS telehealth applicability is flagged per code.

Telehealth payment is allowed for the listed CPT/HCPCS/G-codes when the specific code entry indicates 'Yes' for telehealth payable and the service is billed in accordance with member benefits and authorization requirements.

Examples of outpatient behavioral health and E/M services payable via telehealth

90791 — Psychiatric diagnostic evaluation (no medical services) — telehealth payable; 2026 CMS telehealth = Yes; Audio-only permitted = Yes.
90832/90834/90837 — Psychotherapy (30/45/60 minutes) — telehealth payable; 2026 CMS telehealth = Yes; Audio-only permitted = Yes.
90792 — Psychiatric diagnostic evaluation with medical services — telehealth payable; 2026 CMS telehealth = Yes; Audio-only permitted = Yes.
G0560 — Safety planning interventions, each 20 minutes — telehealth payable; 2026 CMS telehealth = Yes; Audio-only permitted = Yes.

Examples of outpatient/office visits payable via telehealth

99202–99205 (new patient E/M) — telehealth payable; 2026 CMS telehealth flag = No for many; Audio-only permitted = Yes for listed outpatient visit codes.
99211–99214 (established patient E/M) — telehealth payable; 2026 CMS telehealth flag = No; Audio-only permitted = Yes.

Assessment and testing services payable via telehealth

96116, 96125, 96130, 96132, 96136, 96138 — neurobehavioral/cognitive and psychological testing — telehealth payable; audio-only permitted noted as Yes for many testing codes.
+99418 — Prolonged inpatient/observation service each 15 minutes for administration of a standardized, evidence-based assessment — listed; audio-only permissibility varies in source.
G0136 — Administration of standardized assessment of physical activity and nutrition, 5–15 minutes — telehealth payable; 2026 CMS telehealth = No; Audio-only permitted = No; frequency: not more often than every 6 months.

Inpatient, ED, and higher-complexity telehealth services

G0406/G0407/G0408 — Follow-up inpatient consults (per 15/25/35 minutes) — telehealth payable; 2026 CMS telehealth = No; Audio-only permitted = No.
G0425/G0426/G0427 — Telehealth consult initial inpatient/ED and inpatient pharmacological management (per listed minutes) — telehealth payable; 2026 CMS telehealth = No; Audio-only permitted = No for these G-codes.
99221/99231–99233/99234–99235 — Initial and subsequent inpatient care codes appear on the list; audio-only permissibility varies by specific inpatient code (see code-level entries).

Facility/originating site and other codes

Q3014 — Telehealth originating site facility fee — payable (billed by originating site provider).
+G2211 — care management / continuing focal point code — listed; audio-only indicated as No in source.
G0459 — Psychotherapy (G-code) — telehealth payable; audio-only = No per code entry.

Coverage for any listed code is subject to the provisions and limitations of the member's benefit plan, including any authorization requirements or plan exclusions.

Telehealth code and program coverage criteria

Coverage stance by code with notes on 2026 CMS telehealth status and whether audio-only delivery is permitted; specialty product caveats apply.

Selected inpatient and assessment G-/CPT-level codes

+99418 — Prolonged inpatient/observation service, each 15 minutes — listed for administration of a standardized evidence-based assessment; source indicates presence on the payable list.
G0136 — Administration of a standardized assessment of physical activity and nutrition, 5–15 minutes — covered; 2026 CMS telehealth = No; Audio-only permitted = No; frequency: not more often than every 6 months.
G0406/G0407/G0408 — Follow-up inpatient consults (per 15/25/35 minutes) — covered; 2026 CMS telehealth = No; Audio-only permitted = No.

Initial inpatient/ED consults and inpatient pharmacological management

G0425 (per 30 minutes) and G0426 (per 50 minutes) — Telehealth consult, initial inpatient or emergency department — covered; 2026 CMS telehealth = No; Audio-only permitted = No.

Codes and Coding Rules

telehealth payable codesmixedCovered

90785	Interactive complexity add-on; listed as permitted/Yes for telehealth and audio-only in some contexts
90791	Psychiatric diagnostic evaluation (no medical services) payable via telehealth; audio-only permitted
90792	Psychiatric diagnostic evaluation with medical services payable via telehealth; audio-only permitted
90832	Psychotherapy with patient, 30 minutes — telehealth payable; audio-only permitted
90834	Psychotherapy with patient, 45 minutes — telehealth payable; audio-only permitted
90837	Psychotherapy with patient, 60 minutes — telehealth payable; audio-only permitted
90839	Psychotherapy for crisis, initial 60 minutes — telehealth payable; audio-only permitted
90840	Psychotherapy for crisis, additional 30 minutes — telehealth payable; audio-only permitted
96116	Neurobehavioral status exam — telehealth payable; audio-only permitted
96125	Standardized cognitive performance testing per hour — telehealth payable; audio-only permitted

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Selected inpatient/assessment G- and CPT-level codesmixedCovered

+99418	Prolonged inpatient or observation service, each 15 minutes; administration of standardized, evidence-based assessment
G0136	Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months
G0406	Follow-up inpatient consult, telehealth, per 15 minutes
G0407	Follow-up inpatient consult, telehealth, per 25 minutes
G0408	Follow-up inpatient consult, telehealth, per 35 minutes

Additional telehealth G- and facility codesmixedCovered

G0425	Telehealth consult, initial inpatient or emergency department, per 30 minutes
G0426	Telehealth consult, initial inpatient or emergency department, per 50 minutes
G0427	Inpatient telehealth, pharmacological management, per 70 minutes
G0459	Psychotherapy (telehealth)
G0560	Safety planning interventions, each 20 minutes personally performed by the billing practitioner
+G2211	Care management/continuing focal point for all needed health care services
Q3014	Telehealth originating site facility fee (billed by originating site provider)

OBOT HCPCSHCPCSCovered

H0001	Alcohol and/or drug assessment; detox for opioid addiction using buprenorphine (OBOT)
H0014	Ambulatory detoxification for opioid addiction using buprenorphine (OBOT)

inv-07: Audio-only permissibility — summary of which service types/codes permit audio-only delivery

Service types permitting audio-onlyMany behavioral health (psychotherapy, psychiatric diagnostic evaluation), standardized testing, and outpatient office visit codes are marked as audio-only permitted; examples include 90791, 90792, 90832, 90834, 90837, 96130, 96132, 96136, 96138, 99202-99205, 99211-99214.

Testing and assessment codesPsychological and neuropsychological testing codes (96125, 96130, 96132, +96131, +96133, +96137, 96136, 96138) are listed as audio-only permitted.

Outpatient E/M and psychotherapyOffice/outpatient E/M and psychotherapy codes (99202-99205; 90832-90840) are labeled audio-only permitted where noted in the list.

Some higher-acuity/inpatient/ED codes NOT permittedSelected inpatient, ED, and higher-complexity codes (e.g., many G04xx/G0425-G0427 inpatient consult and some ED codes) are marked Audio-only = No.

Provider Billing & Authorization Notes

Billing Rule

Telehealth payable codes overview

This document is a code-by-code payable-services listing indicating which telehealth codes are payable and whether audio-only delivery and CMS telehealth status apply; it does not itself list prior authorization requirements within the code list.

Documentation Required

Authorization and benefit limits

Coverage and payment for the listed codes are subject to the provisions and limitations of the member’s benefit plan and any applicable authorization requirements; this document does not alter member benefits.

Definitions and Operational Notes

inv-11: Audio-only permitted — definition/flag indicating audio-only permitted

DefinitionAudio-only permitted — the document flags many behavioral health, testing, and outpatient codes as allowable when delivered via audio-only (telephone) communication.

ExamplesCodes explicitly marked audio-only permitted include psychiatric diagnostic evaluations (90791, 90792), psychotherapy codes (90832-90840), and multiple testing codes (96125, 96130, 96132, 96136, 96138).

LimitationsSome inpatient, ED, and higher-complexity codes are marked Audio-only = No; check per-code listing for specifics.

inv-12: 2026 CMS Telehealth Code? — flag meaning whether CMS lists the code as telehealth in 2026

Meaning of flag'2026 CMS Telehealth Code?' indicates whether CMS lists the code as a telehealth-covered service in 2026 (Yes/No per code).

Examples - Not CMS telehealth

Policy Summary

Payermagellan_healthcare

Policy2026 Telehealth Payable Services - Commercial

Policy CodePolicy N/A

Change TypeNo material changes noted

Effective DateN/A

Next Review DateN/A

Key ActionUse this code-by-code payable services list to determine whether a telehealth service (including audio-only where noted) is payable before billing Magellan.

SourceLink

On This Page

G0427 — Inpatient telehealth pharmacological management, per 70 minutes — covered; 2026 CMS telehealth = No; Audio-only permitted = No.

Additional telehealth/facility and care-management codes

G0560 — Safety planning interventions, each 20 minutes — covered; 2026 CMS telehealth = Yes; Audio-only permitted = Yes.
+G2211 — Care management/continuing focal point code — listed; source indicates Audio-only permitted = No for +G2211.
Q3014 — Telehealth originating site facility fee — covered (billed by originating site provider).

Autism Specialty Product services (program-level caveat)

Adaptive behavior treatment and related autism services are shown in the Autism Specialty Product section; these are excluded from member benefits except for plans that include Autism Specialty Product coverage — payment requires plan eligibility and autism diagnosis per the source.
Where Autism Specialty Product codes appear, the source lists 2026 CMS telehealth and audio-only indicators per code (many entries show 'No' for audio-only).

Office-Based Opioid Treatment (OBOT) HCPCS

H0001 — Alcohol and/or drug assessment; detox for opioid addiction using buprenorphine — listed as telehealth-capable; 2026 Telehealth Code? = Yes; Audio-only, permitted? = Yes.
H0014 — Ambulatory detoxification for opioid addiction using buprenorphine — listed as telehealth-capable; 2026 Telehealth Code? = Yes; Audio-only, permitted? = Yes.

Operational note: For each code, follow the source code-level flags for 2026 CMS telehealth applicability and audio-only permissibility. Where the source marks 'No' for audio-only or for CMS telehealth, telephone-only delivery or CMS telehealth status should not be assumed acceptable without additional payer guidance and benefit confirmation.

inv-08: G0136 frequency limit — Not more often than every 6 months

G0136 frequency limitNot more often than every 6 months (Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes).

Related noteG0136 is payable via telehealth per list but CMS telehealth flag = No and Audio-only = No.

Use contextApplies to administration of the standardized assessment of physical activity and nutrition as defined in the code description.

Many office/outpatient visit codes (e.g., 99202-99205) and G0136 are shown with 2026 CMS Telehealth = No in the list.

Examples - Yes entriesSome testing and behavioral health codes are flagged Yes for 2026 CMS telehealth where indicated in the per-code entries.

inv-13: 2026 AMA Telemedicine Code? — flag for AMA telemedicine guidance or add-on indicators

Meaning of flag'2026 AMA Telemedicine Code?' indicates AMA telemedicine guidance or related telemedicine/add-on codes referenced for the service (e.g., listed add-on codes such as +90785, +96131, +96133, +96137).

ExamplesInteractive complexity and several testing codes include AMA telemedicine code references (e.g., +90785, +96131, +96133, +96137).

Use notePresence of an AMA telemedicine code reference does not by itself determine Magellan payable status; refer to per-code payable flag in the list.

inv-14: Q3014 originating site facility fee — note that Q3014 is billed by the originating site provider

Billing responsibilityQ3014 is the telehealth originating site facility fee and is billed by the originating site provider (note in list).

Payable statusQ3014 is included on the payable services list (marked Yes).

ContextQ3014 is shown in the Additional telehealth G- and facility codes section alongside other facility/consult codes (G0425-G0427, G0459, G0560).

inv-15: Telehealth Payable Autism Specialty Product Services — autism specialty product coverage caveat/exclusion note

Coverage caveatAutism Specialty Product services are excluded from member benefits except for plans that include Autism Specialty Product coverage; payment requires member eligibility and autism spectrum disorder diagnosis as specified by the product.

Audio-only and CMS flagsThe autism specialty product code table includes per-code flags for 2026 CMS Telehealth and Audio-only; several ABA/adaptive behavior treatment codes are shown with Audio-only = No in the excerpt.

Provider actionConfirm member plan includes Autism Specialty Product coverage and eligibility before billing—per-code coverage is conditional on the specialty product.