The Continuing Appropriations and Extensions Act, 2026 (CAE 2026), reactivated the COVID-19 telehealth waivers until Jan. 30, 2026, and delayed face-to-face requirements for mental health services.
Better still, the
CAE 2026 closed a potential telehealth payment gap by backdating the extension to Sept. 30, 2025.
That’s good news if your practice continued to perform telehealth services allowed by the waivers during the latest government shutdown. For example, if you provided office/outpatient telehealth visits between Oct. 1 and Nov. 12 to patients who were at home, those services are covered.
If you held claims in hopes that Congress would restore the waivers, you can submit them now, according to a
Nov. 20 notice from CMS. If you submitted telehealth claims for services performed during the shutdown and received denials, you’ll need to resubmit them, CMS says. The agency did not instruct Medicare administrative contractors (MAC) to adjust those claims.
Check your remittance advices for CARC 16 (Claim/service lacks information or has submission/billing error[s]) and RARC M77 (Missing/incomplete/invalid/inappropriate place of service) for telehealth services with dates of service between Oct. 1 and Nov. 12.
CMS also “encouraged” practices to identify patients who were charged for covered telehealth services performed during the shutdown and to refund any overpayments. The agency also cancelled its earlier instructions to report telehealth services with modifier GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit). That means if your practice was issuing courtesy advance beneficiary notices of noncoverage for telehealth services, it must stop doing so.
“These claims are now payable, provided they meet all applicable Medicare requirements," CMS says. "Practitioners may resubmit those returned claims to CMS, as well as submit any other telehealth claims held in anticipation of possible Congressional action. Practitioners are also encouraged to identify which beneficiaries were charged for telehealth services with dates of service on or after October 1, 2025, that are retroactively payable and instead submit applicable claims to Medicare, refunding any overpayment to beneficiaries. Our instruction to practitioners to append the GY modifier on certain telehealth claims is rescinded and providers may resubmit previously denied claims.”
Before you submit, or resubmit, denied telehealth claims, take a moment to make sure the claim is for a service that is covered under one or more telehealth waiver and doesn’t have other mistakes such as the wrong place of service. It is also vital to remember that your telehealth services must meet all privacy and security requirements, such as using a HIPAA-secure platform to perform telehealth services. And keep an eye on claims for dates of service after the shutdown ended in case it took your MAC a few days to implement the change.
The waiver re-up is also a reminder to refresh your team’s knowledge of communications-based services that are not telehealth services and therefore available to all Medicare patients independent of telehealth waivers. For example, CMS issued a reminder that remote physiologic monitoring services (
99453-99454, 99445, 99470 and
99457) are not telehealth services in the final 2026 physician fee schedule.
A basic rule of thumb is that if the code describes a service that is not performed face-to-face, it is not a telehealth service. Other examples include the virtual check-in (
98016), interprofessional communications-based consults
(99446-99449 and
99451-99452), online E/M services (
99421-99423) and online assessment/management services (
98970-98972).
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