Telehealth billing codes changed significantly in 2026. Some pandemic-era flexibilities ended. Others became permanent. If you're coding telehealth visits, you need to know which rules survived and which didn't. Getting this wrong costs you revenue and invites audits.
This post covers what changed with telehealth billing codes in 2026, what stayed the same, and how to bill these services correctly under the current rules.
What telehealth billing codes are still active in 2026
CMS made several telehealth codes permanent after the public health emergency ended. The core CPT codes for evaluation and management visits apply whether the visit happens in person or via telehealth. Use 99202-99205 for new patient office visits and 99211-99215 for established patients.
You can still bill these with place of service (POS) code 02 for telehealth and modifier 95 to indicate the service was delivered via real-time audio-visual technology. That combination tells the payer it was a telehealth encounter.
CMS also kept G2252 on the active list. This code covers brief virtual check-ins lasting 11 to 20 minutes. It's used for quick follow-ups that don't qualify as full E/M visits. The patient initiates the contact, and you can't bill it if it leads to an in-person visit within 24 hours or results from a visit in the previous 7 days.
Remote patient monitoring codes (99453, 99454, 99457, 99458, and 99091) remain billable. These cover device setup, data transmission, and the time you spend reviewing and responding to that data each month. The 20-minute threshold for 99457 still applies.
Geographic restrictions that returned in 2026
The biggest change in 2026 wasn't which codes you can use. It's where your patient can be located when you use them.
During the public health emergency, patients could receive telehealth services from home. CMS allowed POS 02 regardless of the patient's location. That flexibility ended December 31, 2024 for most Medicare telehealth services. As of January 1, 2026, Medicare requires patients to be at an eligible originating site unless the service falls under one of the permanent exceptions.
An eligible originating site includes physician offices, hospitals, rural health clinics, federally qualified health centers, and a few other designated locations. The patient's home doesn't count for standard telehealth visits billed with POS 02 under traditional Medicare rules.
Permanent exceptions to the originating site rule
Mental health and substance use disorder services can still be delivered to a patient's home. CMS extended this exception permanently. If you're billing for these services, the patient location restriction doesn't apply.
Patients who had an in-person visit within the past 12 months can receive certain behavioral health services at home. The 12-month requirement resets with each in-person visit, so you need documentation of that face-to-face encounter.
Telehealth for diagnosis, evaluation, or treatment of stroke also remains available from the patient's home. This exception was made permanent because early stroke intervention saves lives and minutes matter.
Audio-only services and their limits
You can bill some services using audio-only telehealth in 2026, but the list is narrower than it was in 2024. CMS extended audio-only coverage for behavioral health and certain evaluation and management visits through December 31, 2025. That extension expired.
As of January 2026, audio-only visits for standard E/M services no longer qualify for Medicare reimbursement unless they fall under behavioral health categories. For everything else, you need real-time audio and video.
Commercial payers vary. Some states passed laws requiring private insurers to cover audio-only telehealth for certain services. Check your state regulations and payer contracts. Don't assume Medicare rules apply to your commercial claims.
When you bill audio-only services where they're still covered, append modifier 93 instead of modifier 95. Modifier 93 tells the payer the service was delivered using synchronous audio without video.
Reimbursement rate changes you need to know
Payment parity ended for most telehealth services in 2026. During the pandemic, CMS paid telehealth visits at the same rate as in-person encounters. That rule expired for traditional Medicare.
Telehealth visits now pay at the non-facility rate when the physician is located somewhere other than a hospital or facility setting. The non-facility rate is typically lower than the facility rate you'd get for an in-person hospital-based service. You'll see this reflected in your reimbursement when you compare 2026 payments to what you received in 2023 or 2024.
There's an exception: rural health clinics and federally qualified health centers can still bill telehealth at rates closer to their in-person payment structure. If you operate one of these settings, verify your specific billing rules with your MAC.
Some commercial payers maintained payment parity voluntarily or because state law requires it. Contact your top 5 payers and confirm their 2026 telehealth reimbursement policies. Assumptions cost money.
What this means for your revenue cycle
Lower reimbursement rates mean you need to code every service accurately. An incorrectly coded visit that pays 15% less than it should have doesn't just lose you money on that claim. It sets a pattern. If your coders misapply modifiers or use the wrong POS codes, you're underpaid on hundreds of encounters before you notice.
Audit your telehealth claims quarterly. Pull a sample of 25 to 30 encounters and verify that POS codes, modifiers, and documentation match CMS requirements. If you're seeing a denial rate above 5% on telehealth claims, you have a process problem.
Documentation requirements that tightened in 2026
CMS didn't relax documentation standards when telehealth became more common. If anything, auditors pay closer attention to telehealth encounters because the flexibilities during the pandemic created bad habits.
You need to document the patient's location at the time of service. Write where they were physically located. If it was their home and the service qualifies for the home exception, state that in the note. If they were at an eligible originating site, document which one.
Document the technology used. Specify that it was real-time audio-visual communication. If it was audio-only and the service qualifies, note that and explain why video wasn't available. "Patient preference" isn't sufficient. You need a clinical or technical reason.
Record the start and stop time for time-based codes. This applies to remote patient monitoring and prolonged services. If you bill 99457 based on 20 minutes of care management, your note needs to show when that time was spent and what you did during it.
Your telemedicine documentation should support medical necessity just like an in-person visit. The fact that it happened via video doesn't lower the bar. Chart the chief complaint, history, exam findings, assessment, and plan. Skimpy notes get denied.
Common billing errors to avoid right now
Using POS 02 for a patient at home when the service doesn't qualify for the home exception is the most frequent error we see. It triggers a denial and sometimes a request for refund if the claim already paid.
Billing modifier 95 on a service that was audio-only. Use modifier 93 instead, and only if the payer covers audio-only for that code.
Appending modifier 95 to codes that aren't approved for telehealth. CMS maintains a list of telehealth-eligible codes. If your code isn't on it, don't bill it as telehealth. You'll get denied or flagged for review.
Coding an E/M level higher than the documentation supports because the visit took longer via video than it would have in person. Time spent troubleshooting tech issues doesn't count toward your level of service unless it's medically relevant. Base your code on the complexity of the medical decision-making or the time spent on evaluation and management, not connection problems.
Not checking state licensure requirements before billing telehealth across state lines. Medicare doesn't care where your patient is located as long as the site rules are met. State medical boards do. Bill a service to a patient in a state where you're not licensed and you've got a legal problem, not just a coding problem.
How MedCodex Health keeps your telehealth claims clean
Telehealth rules change faster than most coding teams can track. One missed CMS update and you're billing under expired policies. Your denials go up. Your revenue drops. You don't notice until the quarterly report shows the damage.
MedCodex Health monitors CMS transmittals, payer policy changes, and state regulations so your team doesn't have to. Our certified coders know which telehealth billing codes apply to which settings, which modifiers to append, and how to document the encounter so it survives an audit.
If your telehealth denial rate is above 5% or you're not sure whether your team is applying the 2026 rules correctly, MedCodex Health can run a free chart audit on 20 of your recent telehealth encounters. We'll tell you exactly where the errors are and what they're costing you. No sales pitch. Just a report you can use.
Frequently asked questions about telehealth billing codes
Can I bill telehealth codes if the patient is at home in 2026?
You can bill telehealth services to a patient's home only if the service qualifies for a permanent exception. Mental health services, substance use disorder treatment, and stroke-related care are allowed from home. Standard E/M visits for Medicare patients require the patient to be at an eligible originating site unless one of the exceptions applies.
What's the difference between modifier 95 and modifier 93?
Modifier 95 indicates the service was delivered using real-time audio and video technology. Modifier 93 indicates the service was delivered using audio-only synchronous communication. Use modifier 93 only when the payer covers audio-only telehealth for that specific code and the service doesn't require video under CMS rules.
Do commercial payers follow the same telehealth rules as Medicare in 2026?
No. Commercial payers set their own telehealth policies. Some states require private insurers to cover telehealth at parity with in-person visits, and some don't. You need to verify coverage, reimbursement rates, and documentation requirements with each payer individually. Don't assume Medicare rules apply to your commercial claims.
What happens if I bill a telehealth code that's no longer covered?
The claim will be denied. If it pays initially and later gets reviewed, the payer will recoup the payment. Repeated incorrect billing can trigger an audit of all your telehealth claims from the past 12 months. If the payer finds a pattern, you'll owe refunds and possibly penalties.
How often should I audit my telehealth claims?
Audit a sample of 25 to 30 telehealth claims every quarter. Check for correct POS codes, appropriate use of modifiers 95 or 93, documentation of patient location, and support for the level of service billed. If your denial rate is above 5%, audit monthly until you identify and fix the root cause.