We want to make you aware of some telehealth flexibilities that Tufts Health Plan is extending for Medicare members and offer guidance on telehealth billing for these members.
Telehealth billing guidance
When billing for telehealth services for Medicare members, please be aware that Tufts Health Plan will accept CPT telehealth codes 98000–98015 for dates of service through Dec. 31, 2025, although the Centers for Medicare and Medicaid Services (CMS) does not offer coverage of these codes.
However, for dates of service beginning Jan. 1, 2026, these codes will no longer be reimbursable for Tufts Medicare Preferred, Tufts Health One Care, and Tufts Health Senior Care Options members. For dates of service as of Jan. 1, 2026, please adhere to the following coding guidelines — and note that this is also the recommended approach for billing telehealth services prior to Jan. 1.
When submitting a professional claim for services provided via telehealth, providers should use the appropriate evaluation and management (E/M) code along with a place of service (POS) code and the appropriate modifier.
Bill using one of the following required POS codes:
- POS 02 — telehealth service provided in the patient’s home
- POS 10 — telehealth service provided other than in patient’s home
Required modifiers for Medicare members include: 93, 95, GT, GQ, FQ, FR, G0.
For modifier descriptions and complete details, refer to the Telehealth/Telemedicine Payment Policy.
Supporting telehealth for our members
In addition, the extension that CMS put into place for COVID-related telehealth flexibilities is scheduled to end on Sept. 30, 2025. When this occurs, Medicare will no longer cover telehealth for all sites of service. Recognizing the convenience of telehealth for our Medicare members, we will continue to cover telehealth for a variety of services and all sites of service as a supplemental benefit for members of our Tufts Medicare Preferred, Tufts Health OneCare, and Tufts Health Senior Care Option products.
Effective Oct. 1, 2025 and carrying over into the 2026 benefit year, the following codes remain eligible for telehealth reimbursement:
| Category | Allowable codes |
| Cardiac rehabilitation services | 93797, 93798 |
| Group sessions for mental health specialty services | 97150, 97154, 97156, 97157, 97158, 96202, 96203 |
| Individual sessions for mental health specialty services | 90875, 0326T, 97129 |
| Individual sessions for psychiatric services | 96110, 96125, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96170, 96171, 97130, 97151. 97152, 97153, 97155 |
| Intensive cardiac rehabilitation services | G0422, G0423 |
| Kidney disease education services | 90953, 90956, 90959, 90962 |
| Other health care professionals | G0248, 97550, 97551, 97552, G0539, G0540, G0541, G0542, G0543, 98960, 98961, 98962, 0591T, 0592T, 0593T |
| Partial hospitalization program | G0410 |
| Physical therapy and speech language pathology services | 92507, 92508, 92521, 92522, 92523, 92524, 96105 |
| Physician specialist services | 77427, 94005, 94664, 95970, 95983, 95984 |
| Pulmonary rehabilitation services | 94625, 94626 |
Summary of changes
The following chart offers a summary of the changes noted in the sections above for telehealth for Medicare members by date of service.
| Telehealth coding guidance | ||
| Dates of service | Codes covered | Additional information |
| 1/1/2025 – 10/1/25 | 98000–98015 (new codes released in 2025) | While not covered by Medicare, Tufts Health Plan will cover for: Tufts Medicare Preferred, Tufts One Care and Tufts Senior Care Options |
| E/M codes with telehealth POS codes
|
Covered by Medicare for all sites | |
| 10/1 (or end of Covid telehealth flexibilities) –12/31/25 | 98000–98015 (new codes released in 2025) | While not covered by Medicare, Tufts Health Plan will cover for: Tufts Medicare Preferred, Tufts One Care and Tufts Senior Care Options |
| E/M codes with telehealth POS codes
|
Medicare will not cover all sites of service. For Tufts Medicare Preferred, Tufts One Care and Tufts Senior Care Options, we will cover certain codes and all sites of service. | |
| 1/1/26 and beyond | 98000–98015 (new codes released in 2025) | Not covered by Medicare. No covered by Tufts Health Plan for: Tufts Medicare Preferred, Tufts One Care and Tufts Senior Care Options |
| E/M codes with telehealth POS codes | Medicare will not cover all sites of service. For Tufts Medicare Preferred, Tufts One Care and Tufts Senior Care Options, we will cover certain codes and all sites of service. | |
In addition:
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