FLASH: New Telehealth Requirements and Coding

For Medicare Advantage Plans

With the action taken by Congress in late 2024, telehealth requirements for Medicare Advantage patients will remain the same for the first part of 2025. Providers should continue to bill claims as they have in the past for those services and not utilize the new 98000-98015 CPT codes that became effective on January 1, 2025. There is now a reimbursement guide on our website that serves as a reference for defining telehealth and how to properly bill those services. There may be further Congressional action that will impact this later in 2025. Health Alliance™ will not reimburse any Medicare Advantage telehealth services billed with CPTs 98000-98015 for 2025 dates of service. Acceptable places of service are 02 and 10 for these services.

For Commercial Plans

Only the new CPT codes should be utilized when billing for telehealth services for Commercial plan patients. A reimbursement guide is available on our website to guide providers on what is and is not acceptable for billing telehealth services for Commercial patients. Health Alliance will no longer accept telehealth services billed with CPTs outside of 98000-98015.  Acceptable places of service are 02 and 10 for these services.