CY2026 Medicare Physician Fee Schedule

Behavioral health telehealth after 2025. The dated timeline your intake team can actually rely on.

The short version: for mental and behavioral health, telehealth into the patient's home is permanent, audio-only is permanent, and your POS and modifier choices are settled. Here is exactly what became permanent, what got extended, and what quietly lapsed, with the codes to key.

Place of service
POS 10
Telehealth in the patient's home. Use POS 02 when the patient is anywhere else.
Modifier, audio + video
95
Real-time interactive audio-video. Your default for a standard telehealth BH session.
Modifier, audio-only
93
Permanent for mental health when the patient cannot use or declines video, in the home.

Keep this near the intake screen

Four things intake stops guessing about

Every dropped claim we see in behavioral health telehealth traces back to one of these four fields being picked from memory instead of policy. Lock them and the guessing stops.

POS 10
Patient at home (permanent for BH)
POS 02
Telehealth, patient not at home
Mod 95
Synchronous audio + video
Mod 93
Audio-only, mental health carve-out

The chronology

How each allowance got here

Gold nodes are permanent in statute or rule. Cyan nodes are extensions with an end date. Gray nodes have lapsed. Read top to bottom and you have the whole story.

Mar 2020Lapsed origin
The public health emergency waivers begin

The pandemic-era blanket flexibilities opened telehealth to nearly everything. Useful to remember only because most of what people still call "the telehealth rules" came from this temporary window, and that window closed. What survived it is what matters below.

Consolidated Appropriations Act, 2021Permanent
Mental health telehealth in the home, no geography test

Congress permanently removed the originating-site geographic restriction and added the patient's home as an eligible originating site, specifically for mental and behavioral health. This is the anchor. It does not sunset. It is why POS 10 is a real, standing answer for BH and not a temporary courtesy.

Home = originating siteNo rural testBH-specific
CY2022 to CY2024 rulemakingPermanent
Audio-only becomes a real Medicare modality for mental health

CMS permanently amended the definition of "interactive telecommunications system" so audio-only counts for mental and behavioral health when the patient is in the home and either cannot use or does not consent to two-way video, and the practitioner is technically able to use video. That is the legal basis for Modifier 93 on a BH claim, not a workaround.

Modifier 93Home onlyVideo-capable practitioner
CY2025 Physician Fee Schedule Final RulePermanent + new codes
The framework holds, and digital mental health arrives

CMS kept the POS and modifier structure intact and finalized new codes for digital mental health treatment devices (G0552, G0553, G0554) used alongside ongoing behavioral care. The in-person visit condition attached to home-based mental health telehealth stayed under a delay rather than switching on.

G0552G0553G0554
Oct 1, 2025Cliff, non-BH
The general telehealth flexibilities hit their statutory edge

The broad, non-behavioral Medicare telehealth waivers were tied to a statutory expiration and moved on short-term extensions. This is the part that makes headlines and scares intake. It is also the part that does not touch mental and behavioral health, which stands on its own permanent footing. Watch it for your medical lines, not your BH lines.

CY2026 Physician Fee Schedule Final RuleIn effect Jan 1, 2026
The list gets simpler, the BH ground stays solid

CMS simplified the Medicare Telehealth Services List by retiring the "provisional versus permanent" split and eased frequency limits on certain services. For behavioral health, the substance is unchanged: home as originating site, audio-only for mental health, and the POS 10 / POS 02, Modifier 95 / 93 mapping all carry forward. Confirm the in-person visit condition's effective posture in the final rule before you build hard edits around it.

Simplified listPOS 10 / 02Mod 95 / 93

Permanent vs extended vs lapsed

The one table to settle an argument

AllowanceStatus for 2026What intake keysSource, by name
Home as originating site, mental / behavioral health Permanent POS 10 Consolidated Appropriations Act, 2021
No geographic (rural) restriction for BH telehealth Permanent No rural test needed Consolidated Appropriations Act, 2021
Audio-only for mental health in the home Permanent Modifier 93 Interactive telecommunications system definition, PFS
Synchronous audio-video BH session Permanent Modifier 95 Medicare Telehealth Services List, CY2026 PFS
Digital mental health treatment device services Active G0552 / G0553 / G0554 CY2025 PFS Final Rule, carried into CY2026
Broad non-behavioral telehealth flexibilities Extended, watch Verify by date of service Statutory extensions after Oct 1, 2025
PHE blanket telehealth waivers Lapsed Do not rely on Public Health Emergency, ended

The trap worth naming. The in-person visit condition for home-based mental health telehealth has been written into law and then delayed more than once. Do not hard-code a denial or a warning around it until you have read its exact effective posture in the CY2026 Physician Fee Schedule Final Rule for your dates of service. Treat it as a policy to confirm, not a rule to assume.

Behavioral Health Integration

The BHI codes that ride alongside telehealth

Integration and collaborative care are month-long, team-based services billed by the treating practitioner. They are how primary care and behavioral health get paid to work together, and they pair naturally with the telehealth allowances above.

General BHI
99484
General behavioral health integration, per calendar month, at least 20 minutes of clinical staff time.
CoCM, initial
99492
Psychiatric Collaborative Care Model, first month, 70 minutes.
CoCM, subsequent
99493
Collaborative Care, subsequent month, 60 minutes.
CoCM, add-on
99494
Each additional 30 minutes of Collaborative Care in a calendar month.
BHI, non-physician
G0323
General care management for behavioral health by clinical psychologists and social workers.
RHC / FQHC
G0511
General care management in rural health clinics and FQHCs, including BHI time.

At the point of intake

The five-second decision, in order

1

Is this a mental or behavioral health service?

If yes, you are on the permanent track. The home and audio-only allowances apply and you do not need the general telehealth waivers to survive.

2

Where is the patient sitting?

Patient's home, key POS 10. Anywhere else, key POS 02. This is the field that most often gets picked from habit.

3

Video or audio-only?

Two-way audio and video, append Modifier 95. Audio-only because the patient cannot use or declines video, append Modifier 93, and note the reason in the chart.

4

Is this a monthly integration service?

Collaborative care or general BHI gets its own family, 99484, 99492 to 99494, or G0323 / G0511 in RHC and FQHC settings, tracked by minutes across the calendar month.

5

Confirm the in-person condition for your dates of service.

Before any automated edit fires, check the current posture of the mental health in-person visit requirement against the CY2026 Physician Fee Schedule Final Rule. Assume nothing.

Turn this timeline into a clean claim, every time

Knowing the rule is half of it. The other half is an intake and billing workflow that keys the right POS and modifier without a second thought, and catches the one that slipped. That is the work our behavioral and mental health billing team does for practices every day.

Talk to ASP-RCM about BH billing
ASP-RCM Solutions, Senior Partner, Frisco