After years of short-term extensions and looming deadlines, Congress has finally delivered a measure of stability for Medicare telehealth. The Consolidated Appropriations Act, 2026 (H.R. 7148), signed into law early February, retroactively extends the Medicare telehealth waivers that briefly expired on January 30, 2026, and continues those flexibilities through December 31, 2027. These waivers, first implemented in 2020 during the COVID-19 public health emergency, have become deeply embedded in how providers deliver care and how patients access it. The nearly two-year extension is significant because it reduces near-term uncertainty and allows providers to maintain current operations.

Significant changes to Medicare Advantage referral requirements are underway, and expectations are not consistent particularly when comparing two major Idaho payors - Blue Cross of Idaho (BCI) and UnitedHealthcare (UHC). Practices can no longer rely on assumptions and must verify the specific insurance product policy before determining whether a referral is required.

On October 21, the Centers for Medicare & Medicaid Services (CMS) released updated guidance to Medicare Administrative Contractors (MACs) regarding the processing of Medicare claims during the ongoing federal government shutdown. The American Medical Association (AMA) has been in active communication with CMS to help clarify previous instructions, as significant confusion had developed among providers about which claims were being processed and paid.

As of October 1, 2025, Medicare telehealth services have reverted to permanent statutory law following the expiration of the temporary waivers first established during the COVID-19 pandemic. Until the shutdown ends, Medicare’s telehealth coverage is again limited to patients located in rural areas and those receiving services in approved medical facilities rather than from home, except in certain limited situations. We highly recommend providers verify location eligibility.

In the CY 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, CMS introduces a significant update to support the integration of behavioral health services within advanced primary care models. Specifically, the proposal outlines a new suite of G-codes, GPCM1, GPCM2, and GPCM3, intended to function as optional add-on services when billed in conjunction with APCM base codes (HCPCS G0556, G0557, or G0558) by the same practitioner during the same calendar month.

Since the release of visit complexity code, there has been confusion on its use and when it should be reported. HCPCS code G2211 is an add-on code to outpatient evaluation and management services only, CPT code sets 99202-99205 and 99211-99215. Other outpatient services and hospital E/M services are not applicable to the visit complexity add-on code.

Giving back to our GCS clients and community, we are delighted to sponsor this free webinar, Parenting for Resilience, January 16th at 6pm Mountain Standard Time. Join us for a Zoom presentation and discussion with Parent Coach and Therapeutic Consultant, Vashti Summervill. 

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed rule for Medicare Physician Payment Schedule (MFS) and other changes to Part B Payment and Coverage Policies. If finalized, these policies will take effect on January 1, 2024, unless otherwise noted. Interested parties have a 60-day comment period, which ends on September 11, 2023, to provide feedback and comments on the proposed rule.

In a recent newsletter, the post-pandemic virtual care policy was published and covers most current regulations.  Idaho Medicaid uses virtual care and telehealth interchangeable and defines this as “providing medically necessary health care services without actual physical contact, through the use of electronic means.” Patient and provider need to be interacting in real-time or “live” from two physically different locations, by video or telephone. Idaho Medicaid requires that whomever is providing virtual care must be within provider’s scope of practice and billed as per Medicaid regulations and accurate NPI. 

Over the years, the AMA and payors have continued to clarify and refine drug management as a part of the medical decision-making risk. In the 2023 guidelines, within the medical complexity tables, column three, there are separate areas addressing prescription drug management (categorized as moderate risk), drug therapy requiring intensive monitoring for toxicity, and parenteral controlled substance (both categorized as high risk). So, what is the difference between these drug managements and when is the intensive drug therapy monitoring supported? Here are some definitions and tips from the AMA and industry research over these risk categories.