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
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.
- 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
- +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
- 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
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.
Initial inpatient/ED consults and inpatient pharmacological management
- G0427 — Inpatient telehealth pharmacological management, per 70 minutes — covered; 2026 CMS telehealth = No; Audio-only permitted = No.
Additional telehealth/facility and care-management codes
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.
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 |
1–10 of 43
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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) |
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.
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.
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 telehealthMany 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.
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
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