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Medicare/CMSTraditional Medicare · Billing Codes · CodingHigh impact

2026-09-10 - Rural Health Clinics & Federally Qualified Health Centers: Billing Distant Site Telehealth Services

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Sep 29, 2026

Summary

Effective October 1, 2026, RHCs and FQHCs must stop billing HCPCS code G2025 for distant site telehealth services and instead bill individual CPT or HCPCS codes describing the actual service with telehealth modifier 93 (audio-only) or 95 (audio-video). The payment rate for these services is set at $97.53 for CY 2026.

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What to do

by Sep 30, 2026 · 5 steps
01Billing team must update billing software to eliminate G2025 as a billable code for RHCs and FQHCs.
02Create new billing rules requiring individual CPT/HCPCS codes (per the telehealth services list provided by CMS) paired with modifier 93 or 95 based on the type of telehealth delivery.
03Update provider encounter forms and templates to ensure proper service code selection and modifier assignment.
04Train all billing and clinical staff on the new coding requirements.
05Verify that the system correctly applies the $97.53 payment rate for CY 2026.
If missed: Failure to implement these changes will result in claim rejections or denials for all telehealth services billed after October 1, 2026.

Codes mentioned

G20259395

Original notice

2026-09-10 - Rural Health Clinics & Federally Qualified Health Centers: Billing Distant Site Telehealth Services
cms.gov · Always check the source before changing claims.
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Related policy hubs

Medicare/CMS policiesCode G2025Code 93Code 95

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