New distant site telehealth billing requirements to take effect for RHCs, FQHCs on October 1

Rural health clinics (RHC) and federally qualified health centers (FQHC) should be preparing to implement a new billing requirement for distant site telehealth services that takes effect on October 1, 2026.

RHCs and FQHCs were initially authorized to provide distant site telehealth services during the COVID-19 pandemic, and Congress has since extended this authority through January 1, 2028. Under current billing processes, RHCs and FQHCs generally report these services using Healthcare Common Procedure Coding System (HCPCS) code G2025.

However, starting October 1, these facilities will no longer bill HCPCS code G2025 for distant site telehealth services. Instead, they are to bill the individual codes that describe the telehealth service furnished. CMS posts the applicable telehealth codes annually and includes them in the Medicare Physician Fee Schedule (MPFS) final rule.

In addition to reporting the appropriate service code, RHCs and FQHCs must report one of the following modifiers based on how the service was delivered:

• -93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
• -95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system

Although the billing methodology for reporting distant site telehealth services will change, CMS will continue to reimburse RHCs and FQHCs using an annually updated rate. This rate is based on the average amount for all MPFS telehealth services and weighted by volume, but it is not adjusted for geographic locality.

RHCs and FQHCs should review their telehealth coding and billing processes before October 1. Read One-Time Notification Transmittal 13776 to learn more about the upcoming changes.