Update: Telehealth flexibilities for Medicare members
November 2025| Tufts Health One Care| Tufts Health Plan Senior Care Options| Tufts Medicare Preferred
We noted in the August issue of the provider newsletter that Point32Health decided to extend some telehealth flexibilities for Medicare members and wanted to provide additional information in light of recent announcements from the Centers for Medicare and Medicaid Services (CMS).
Reminder on Point32Health coverage
Certain telehealth flexibilities that CMS put in place during the COVID pandemic were due to expire Sept. 30, 2025 barring action from lawmakers — and the government shutdown, which began on Oct. 1, 2025, has led to uncertainty about the status of these flexibilities. When the government reopens, lawmakers and CMS may decide to let the expiration of these flexibilities stand or may extend the flexibilities to continue coverage.
Anticipating that CMS may not continue to extend telehealth flexibilities, and recognizing the convenience of telehealth for our Medicare members, Point32Health 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 One Care, and Tufts Health Plan Senior Care Options products — regardless of CMS’ determination.
Effective Oct. 1, 2025, and carrying over into the 2026 benefit year, the following codes will be added to our existing supplemental telehealth benefit and will 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 |
Claims guidance from CMS
In addition, on Oct. 10, 2025, CMS instructed Medicare Advantage organizations to temporarily hold claims for the telehealth flexibilities that expired on Oct. 1, pending further guidance.
Please note that we will continue to process claims for the telehealth flexibilities that we are covering as supplemental benefits. These updates will remain in place, and those claims will be processed.
For telehealth services that expired on Oct. 1, meaning those that CMS is not currently covering and Point32Health did not add as supplemental benefits, we will pend claims in accordance with CMS guidance. We are closely monitoring CMS updates, and will process or deny these claims consistent with further guidance from CMS.
For guidance on billing for telehealth services, providers should refer to the Point32Health Telehealth/Telemedicine Payment Policy.