RHC and FQHC claims manual aligns telehealth and deductible instructions
Oct 4, 2026 edition · GC-2026-0159 · Published 2026-10-04 · Version 2 · Final
CMS’s October manual alignment clarifies distinct RHC/FQHC telehealth billing and deductible treatment under existing policy.
What happened
CMS issued September 29 Transmittal 13975, CR 14625, revising Chapter 9 telehealth and Part B deductible instructions effective October 1 with October 5 implementation. It aligns the manual with the May 27 distant-site billing instruction and expressly states there is no policy change associated with this transmittal. The revised nonbehavioral distant-site section directs individual CPT or HCPCS service codes instead of G2025 from October 1, with the appropriate revenue code and modifier 93 for audio-only or 95 for audio-video. Preventive-service cost sharing is waived without needing the former CS modifier.
The manual treats mental-health telecommunications visits separately: they are billed like in-person visits with the appropriate 93 or 95 modifier rather than G2025. It also distinguishes the originating-site facility fee, billable with revenue 0780 and Q3014, from distant-site services. Ordinary FQHC services are not subject to the Part B deductible, while the originating-site telehealth fee has the stated deductible exception; RHC deductible collection follows the manual and preventive-service exception. As of October 4, clinics should verify October coding and cost-sharing configuration before October 5 implementation rather than interpret the manual alignment as a newly created telehealth entitlement.
Scope and timing
- Authority status
- Final
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Revenue Cycle, Compliance, Clinical Operations
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-05
- Date type
- implementation
Why it matters
Different service contexts and clinic types produce different claim-code and deductible treatment, despite a common telehealth label.
Recommended action
Validate mental-health, nonbehavioral distant-site and originating-site workflows separately, including modifiers, preventive waivers and deductible rules, and reconcile October 5 implementation with the prior instruction.
Implementation playbook
- Compare clinic billing templates with the updated manual and the previously issued distant-site telehealth instruction. Revenue Cycle · Due 2026-10-05
- Record the applicability assessment and validate the affected workflow with its operational owner. This is an internal review target, not an additional statutory deadline. Compliance · Due 2026-10-12
Sources
- CMS Transmittal R13975CPOfficial · Centers for Medicare & Medicaid Services · 2026-09-29 · Source review 2026-10-04
Complete edition and supplemental material
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