Hello SIG Members,
Please see below for CY2026 Physician Fee Schedule final rule updates.
Key Final Telehealth and Virtual Care Policies (CY 2026)
1. Telehealth Services List Process
- CMS will streamline adding services to the Medicare Telehealth Services List by removing Steps 4 and 5 and eliminating the provisional and permanent categories.
2. Additions to the Telehealth Services List (Effective CY 2026)
- Multiple-Family Group Psychotherapy – CPT 90849
- Group Behavioral Counseling for Obesity – CPT G0473
- Infectious Disease Add-on – CPT G0545
- Auditory Osseointegrated Sound Processor Services – CPT 92622, 92623
3. Telehealth Codes and Coverage Updates
- G0136 (Health Risk Assessment) – retained on the Telehealth Services List (CMS withdrew the proposal to delete)
- HCPCS G0552 (Behavioral Health Integration) – CMS will work with MACs to clarify billing rules and may consider national pricing in future rulemaking
- RTM, RPM, and DMHT services – no place of service code required
4. Critical Care and Frequency Limitations
- Removes telehealth frequency limits for critical care consultations and certain inpatient/nursing facility services
5. Direct Supervision Definition
- Permanently adopts a definition allowing "immediate availability" via real-time audio/video communication for services under §410.26 (excluding surgical services with 010 or 090 global periods)
6. Teaching Physician Flexibility
- Virtual presence of teaching physicians is permanently allowed across all settings when services involve a three-way telehealth visit (physician, resident, and patient in separate locations)
7. Digital Mental Health Therapeutic (DMHT) Devices
- Finalizes payment for FDA-cleared or De Novo-authorized DMHT devices for ADHD digital therapy
- Clarifies that patients must have a mental health diagnosis; the billing practitioner does not need to make the original diagnosis
8. Medicare Diabetes Prevention Program (MDPP)
- Establishes a temporary four-year "online delivery period" (Jan 2026 – Dec 2029) to test asynchronous MDPP delivery
- MDPP suppliers may operate virtually; clarify that MDPP suppliers are not required to maintain in-person delivery capability through December 31, 2029.
9. Provider Enrollment and Location Policies
- CMS will not extend the temporary home address policy; guidance remains available via CMS FAQ
- State licensure and Medicare enrollment requirements continue to apply
- Future policy updates will occur through subregulatory guidance, not formal rulemaking
10. Remote Monitoring
- Finalized changes to allow billing for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) when data is collected for 2 to 15 days in a 30-day period (previously, a minimum of 16 days was required)
------------------------------
Alexis Apple
Director, Federal Affairs
American Telemedicine Association
------------------------------