Effective Date: Nov. 1, 2026

Health Plans Affected: US Family Health Plan (USFHP)

Type of Change: Codes and Authorization Requirements Status

Explanation of Change:

Due to a systems error, the following telehealth codes were incorrectly designated as Prior Authorization Required (PA). They are being re-classified as No Prior Authorization Required as of Nov. 1, 2026.

USFHP Telehealth Codes Changed to NPA on Nov. 1, 2026:

• 98000 – Telehealth evaluation‑and‑management (E/M) code for a new patient synchronous audio‑video visit requiring medically appropriate history/exam, straightforward medical decision‑making, and at least 15 minutes of total time on the date of the encounter.
• 98001 – Synchronous audio‑video telehealth E/M service for a new patient requiring low‑complexity medical decision‑making, and at least 30 minutes of total time on the date of the encounter.
• 98002 – New patient telemedicine visit involving moderate medical decision-making and at least 45 minutes of total time on the date of the encounter.
• 98003 – Synchronous audio-video E/M visit for a new patient requiring high medical decision-making and at least 60 minutes of total time on the date of the encounter.
• 98004 – Synchronous audio-video E/M visit for an established patient, requiring straightforward medical decision-making and at least 10 minutes of total time on the date of the encounter.
• 98005 – Synchronous audio‑video E/M visit with an established patient that involves low medical decision making and at least 20 minutes of total time on the date of the encounter.
• 98006 – Telehealth-specific code for a synchronous audio‑video E/M visit for an established patient requiring moderate medical decision‑making and at least 30 minutes of total time on the date of the encounter.
• 98007 – Synchronous audio‑video E/M visit with an established patient that involves high‑complexity medical decision‑making or approximately 40 minutes or more of total time on the date of the encounter.