Highmark’s Telehealth Policy Will Be Updated on Sept. 1

Effective Sept. 1, 2026, Highmark will update its telehealth policy to align with guidance from the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA).

Highmark defines the term “telehealth,”  to encompass a broad spectrum of services delivered via telecommunication technologies, including videoconferencing, and is used synonymously with telemedicine, virtual care, and eVisit services.

CMS: Approved Telehealth Codes – Commercial and Medicare Advantage

CMS currently accepts nearly 300 CPT codes for appropriate telehealth services. Highmark will follow CMS guidance for these codes across all our service regions for both Commercial and Medicare Advantage (MA) lines of business.

AMA: Approved Telehealth Codes – Commercial ONLY

Effective Sept. 1, 2026*, Highmark will adopt the use of the following CPT codes for Evaluation and Management (E/M) telehealth services recommended by the AMA for our Commercial plans:

• Synchronous audio-video: 98000—98007.
• Synchronous audio-only: 98008—98015.

*NOTE: These codes will be effective on Sept. 1 for providers in Delaware, Pennsylvania, and West Virginia. Our New York service regions adopted the use of these codes in 2025.

What’s Changing

For many physicians providing telehealth services to Highmark members, not much.

Highmark’s top telehealth services — including many related to behavioral health care —remain eligible under the updated requirements contingent upon member benefits.

Effective Sept. 1, Highmark will only accept the telehealth services recognized by CMS and those E/M services that qualify for telehealth under AMA guidelines.

Services not on the CMS list and those that aren’t eligible as telehealth under the AMA guidelines will require members to be seen in-person or face-to-face by their provider.

Submitting Telehealth Claims

To facilitate accurate claims processing, including pricing, eligibility, and benefit application for professional telehealth services (utilizing the 1500 form), the following Place of Service (POS) codes must be employed and be consistent with CMS directives:

• POS “02”: For services furnished outside the patient's home.
• POS “10”: For services furnished within the patient's home.