Telehealth Services Guiding Principle: Location, Location, Location & Payer Rules

Key Takeaways from the CMS CY 2026 Final Rule (Effective 1/1/2026)

This telehealth guide is now updated to reflect all final policies in the CMS CY 2026 Final Rule, effective January 1, 2026.
The 2026 CMS changes and additions mark a historic pivot to permanent, simplified and expanded telehealth access under Medicare.
The most critical compliance factor for telehealth billing is knowing the patient's location (the "Originating Site") and which payer's policies you are following (Medicare, Medicaid, or commercial insurance). Policies are payer-specific.

Key 2026 Changes & Simplifications

1. Major Process Simplification

New 3-Step Telehealth Services List Review. CMS has replaced the prior 5-step process for adding telehealth services to the Medicare Telehealth List.

2. Provisional Status Elimination

All services will have permanent status on the List. Existing "provisional" (Category 3) services are being added to the List on a permanent basis for long-term certainty.

3. Significant Expansions of Covered Services

New Permanently-Added Codes to the Telehealth List: 90849, G0473, G0545, 92622, 92623
Removal of Frequency Limits: CMS is permanently eliminating the frequency limits for:
Subsequent inpatient visits (99231-99233)
Subsequent nursing facility visits (99307-99310)
Critical care consultations (G0508-G0509)

4. Key Flexibilities Are Now Permanent

Direct supervision may now be permanently furnished using real-time, interactive audio/video technology (other than the use of the interactive telephone). This policy is now permanent and applies to all practitioners.
Teaching physician services: the flexibility for teaching physicians to furnish supervision of residents using interactive telecommunications technology in order to meet Medicare requirements for teaching physician involvement when the teaching physician and resident are in different locations and the service is furnished via Medicare telehealth is now permanent. This is a big development for the "3-way" telehealth visit model (patient, resident, and teaching physician in different locations).

5. Originating Site = Patient's Home (POS 10) is Permanent

Originating site (also referred to as the Place of Service or POS) means the patient location. The patient's home (POS 10) is now permanent, eligible originating site with no geographic restrictions.

6. Practitioner Home Billing Flexibility

A practitioner who provides telehealth services from their home can continue to bill using the enrolled practice location address for privacy and safety purposes. This policy is finalized through sub-regulatory guidance and not included in the rule, so it does not need to be renewed annually.

7. Telehealth Use of G0136 for SDOH Assessment

Medicare clearly permits use of G0136 for SDOH Risk Assessment when it is performed as part of a Medicare AWV furnished via telehealth.

Reminder: Many key telehealth billing compliance safeguards for Medicare and the industry overall have not changed. The table below highlights where your telehealth billing accuracy is vulnerable and what to do.

Telehealth services must be documented to support the service rendered regardless of the modality used.

Documentation Best Practices

1. Clear Notation of Modality Used

"Synchronous audio-video telehealth" or "Audio-only telephone." For new added codes such as 90849, ensure your notes indicate it was provided "via telehealth" and was a "Multiple-family group psychotherapy" session.

2. Location Documentation in the Record

Continue to document the patient's physical location/address and your own location/address. For a practitioner at home, the record should still reflect the practice address—not the home address.

3. Medical Necessity When the Frequency Limits are Removed for Subsequent Inpatient or Nursing Facility Visits

The documentation must reflect and clearly justify the medical necessity for each such encounter. Boilerplate documentation is unacceptable.

4. Documentation for Supervision

When using direct supervision, the practitioner's availability and involvement (done in real time) needs to be included in the record. Note that the direct supervision standard does NOT require the supervising practitioner to be in the same room.

Coding & Billing Reference Table

This is where accuracy matter most. The following table summarizes the most common codes.

Modality/Service Type	Common CPT / HCPCS Codes	Place of Service (POS)	Modifier	Key 2026 Updates & Billing Notes
Synchronous Audio-Video (Telehealth)	Office Visits (99202-99215); Psychotherapy; etc.	POS 10 (Patient Home) POS 02 (Other Site)	95	POS 10 is permanent. Use modifier 95.
Newly Added Telehealth Services	90849, G0473, G0545, 92622, 92623	POS 02 or 10 as applicable	95	Permanently added to the Medicare Telehealth List.
Subsequent Inpatient/Nursing Facility Care	99231-99233, 99307-99310	POS 02 or 10 (Patient's Location)	95	► MAJOR CHANGE: Frequency limits are permanently removed. Bill as medically necessary.
Critical Care Consultations	G0508, G0509	POS 02 or 10	95	► MAJOR CHANGE: Frequency limits are permanently removed.
Audio-Only (Telephone)	99441-99443 (Medicare)	POS where you are located (e.g., 11).	None	For established patients only. Not considered "Medicare Telehealth."
Virtual Check-In / E-Visits	G2012, G2010 / 99421-99423	POS where you are located (e.g., 11).	None	Rules unchanged. Patient-initiated, brief digital communications.

Key Compliance Pitfalls to Avoid

1. Practice Improvements

Leverage new freedoms correctly. The removal of frequency limits for subsequent inpatient/SNF visits is a major expansion. Ensure clinical documentation is robust to support medical necessity for each telehealth encounter in these settings.

2. POS is Still Wrong

The #1 billing error continues to be using POS 11 for Medicare telehealth. For real-time audio-video visits with a patient at their home, the POS must be POS 10 (home).

3. New Codes are New Codes

Ensure the new permanently added codes are in your telehealth code sets and charge masters. Check with private payers for their coverage policies.

4. Supervision

While direct supervision using telehealth is now permanent, ensure your clinic's policies and record-keeping match CMS expectations for the required level of involvement.

5. Payer Policies can Diverge

Commercial payers and Medicaid Managed Care plans are not required to align their policies with these Medicare changes. They may not have removed frequency limits or added the new codes. Conduct a proactive payer policy review for 2026.

Proactive Action Plan

1. Update your Systems

Ensure your EHR and billing software are updated to include new codes and to reflect permanent POS 10 and elimination of frequency edits.

2. Educate Clinical Staff

Inform physicians, NPs, therapists, social workers about the new codes and the significant change allowing more frequent telehealth visits for inpatient/SNF care.

3. Revise Internal Compliance Audits

Update your internal audit protocols to check for use of new codes, POS 10, and to ensure documentation supports medical necessity in the absence of frequency limits.

4. Engage your Payers

Reach out to your major commercial and Medicaid Managed Care payers to understand their 2026 telehealth policy alignment (or non-alignment) with these CMS changes.

Reminder: This telehealth guide focuses on the Medicare PFS Final Rule by CMS for CY 2026. Medicaid (state-by-state) and private payer telehealth policies may differ. Always consult the latest official resources and payer-specific guidance before changes are made.