Medicare AdvantageCoverageMedium impact
Telehealth
HMSA·HI · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider News
Effective date
Oct 1, 2025
We identified it
Oct 4, 2026
Summary
HMSA updated its telehealth policy to clarify coverage for audio-only visits across multiple plan types, effective October 1, 2025 for Medicare Advantage. Audio-only visits are now covered for behavioral/mental health services and certain medical services, reimbursed at 80% of the standard in-person rate. Billing teams must verify patient plan type and apply correct reimbursement rates for audio-only telehealth claims.
Action Required
By September 15, 2025: Billing team must review HMSA's 'Audio-Only Coverage for Medical and Behavioral Health Visits – Coding Guidelines' document for specific CPT/HCPCS codes applicable to audio-only visits. Update billing system to: (1) identify audio-only telehealth claims by plan type (Medicare Advantage, QUEST Integration, Commercial); (2) apply 80% reimbursement rate for audio-only visits versus standard in-person rates; (3) route claims to correct fee schedule based on member eligibility. Providers must ensure they are technically capable of audio-video communication before billing audio-only services. For QUEST Integration and Commercial plans, apply audio-only coverage only until December 31, 2025, then revert to standard telehealth billing. Contact HMSA Provider Relations if your practice needs clarification on eligible service codes or member plan eligibility verification.