Highmark Commercial Telehealth Coding Changes for Providers

Last updated: September 10, 2026.

Direct answer: Highmark’s Commercial plans now permit CPT 98000–98007 for synchronous audio-video E/M visits and 98008–98015 for synchronous audio-only E/M visits. For providers in Pennsylvania, Delaware, and West Virginia, the stated effective date is September 1, 2026. Read Highmark’s announcement.

Do not automatically convert every telehealth 992xx service. Highmark’s public materials permit the 980xx family, but they do not clearly publish a mandatory one-to-one 992xx-to-980xx crosswalk or settle the exact modifier treatment for every 980xx line. Verify the service, plan, date, modality, and current coding guidance before changing a claim.

Key Takeaways

• Commercial only: the new 980xx direction applies to Highmark Commercial plans. Highmark says Medicare Advantage continues to follow CMS telehealth guidance.

• September 1 in three states: the 2026 effective date applies to Pennsylvania, Delaware, and West Virginia. Highmark says its New York regions adopted the codes in 2025.

• Modality is built into the code family: 98000–98007 are synchronous audio-video E/M codes; 98008–98015 are synchronous audio-only E/M codes.

• Place of service still matters: Highmark directs professional claims to POS 02 when the patient is outside the home and POS 10 when the patient is in the home.

• Psychotherapy is not automatically recoded: the 980xx family is for telehealth E/M. A psychotherapy service or add-on retains its own CPT and must be evaluated separately.

• Coding does not establish payment: the policy change does not tell a practice its contracted rate, billed fee, network tier, or expected allowed amount.

What Changed on September 1, 2026

Highmark announced that Commercial plans would adopt the AMA telehealth E/M codes for dates of service beginning September 1, 2026 in Pennsylvania, Delaware, and West Virginia. The ranges distinguish real-time video visits from real-time audio-only visits:

• 98000–98003: new-patient synchronous audio-video E/M visits.

• 98004–98007: established-patient synchronous audio-video E/M visits.

• 98008–98011: new-patient synchronous audio-only E/M visits.

• 98012–98015: established-patient synchronous audio-only E/M visits.

These are E/M codes, not universal telehealth replacements. A provider should select a code based on the service actually performed, the patient relationship, the visit modality, the documentation, and current CPT and payer guidance. A psychotherapy session does not become a 980xx service merely because it occurred by video or phone.

Who Is—and Is Not—in Scope

The Highmark name alone is not enough to apply this change. A practice needs to distinguish the member’s line of business and the applicable service region before changing its billing workflow.

• Highmark Commercial in Pennsylvania, Delaware, or West Virginia: potentially in scope for eligible dates of service on or after September 1, 2026.

• Highmark Medicare Advantage: not governed by the new Commercial-only 980xx announcement; continue to follow the applicable CMS and plan guidance.

• Dates before September 1, 2026: not brought into scope merely because the claim is submitted after September 1. Use the date of service.

• New York: Highmark says its New York regions adopted the codes in 2025, so the September 2026 three-state change should not be generalized to New York claims.

• In-person visits: outside the telehealth-code path. Report the code and POS appropriate to the face-to-face service.

The Crosswalk Is Not Clear Enough to Automate

Highmark’s public announcement identifies the accepted 980xx ranges, but it does not publish a table requiring each office E/M code in the 992xx family to become one exact 980xx code. That distinction matters because E/M code selection is a clinical coding decision—not a search-and-replace exercise.

The September version of Highmark Reimbursement Policy RP-046 also retains 992xx examples and broad telehealth-modifier language in sections covering virtual office and specialist visits. At the same time, it says Commercial providers may report telehealth E/M with the 980xx family. Those passages confirm that the family is permitted, but they do not clearly prove the reported mandatory crosswalk.

Practical rule: do not bulk-convert historical or future 992xx telehealth services based on a payer announcement alone. Use authoritative coding guidance for the documented visit, and obtain payer clarification when the instruction remains ambiguous.

POS 02 and POS 10

For professional telehealth claims on the 1500 form, Highmark instructs providers to report the place of service based on where the patient received care:

• POS 02: telehealth provided when the patient is outside the home.

• POS 10: telehealth provided when the patient is in the home.

Document the patient’s location and the actual visit modality. An audio-only visit cannot be billed as audio-video, and a submission date cannot repair an incorrect date-of-service or POS decision.

Modifier Treatment Still Needs Care

The public materials do not yet give a sufficiently clear, line-by-line answer for every 980xx scenario. The policy preview includes general instructions for telehealth modifiers such as GT, 93, 95, and FQ, while the 980xx CPT ranges themselves distinguish audio-video from audio-only care. Providers should not assume that the modifier used on an older 992xx telehealth claim automatically carries forward—or automatically disappears.

Modifiers also belong to individual service lines, not to the claim as one undifferentiated block. If an E/M service is billed with a companion psychotherapy add-on, changing the E/M code does not authorize removing the companion CPT, charge, units, or independently applicable telehealth modifier. Evaluate each line using its final CPT and the service actually performed.

Until Highmark’s exact 980xx modifier treatment is confirmed: preserve unrelated service-line information, validate the claim before transmission, and hold an uncertain claim for coding review rather than guessing.

Update the EHR Source Before Filing

If a provider determines that a service line should use a 980xx code, the safest workflow is to correct the actual service in the EHR before assembling the final claim. Changing only the outgoing claim creates two conflicting records: one code in the clinical and billing source, another on the submitted claim.

1. Confirm the applicable plan, state, date, modality, and code. Unresolved facts should stop the correction.

2. Confirm the exact service is configured in the EHR. Review its code, billed fee, duration, and clinician availability. A service-code form accepting a number does not prove payer claim acceptance.

3. Correct the specific source line. Preserve the authored charge, units, date, rendering provider, diagnoses, order, and companion services unless a separately reviewed change is required.

4. Read the encounter back. Verify that the EHR saved the intended CPT and did not change protected line details.

5. Refresh any billing-system mirror. Make sure the claim is built from the verified source state rather than a stale cached version.

6. Validate, then submit once. Confirm the final CPT, POS, modifiers, units, and charge on every line before transmission. If a write or submission result is uncertain, reconcile it before retrying.

SimplePractice documents built-in service selection and custom numeric service codes. Practices using SimplePractice can review its service-code setup guide, but should still separately verify that a saved service prepares correctly on a Highmark claim.

Do Not Treat Another Clearinghouse as a Coding Fix

If the EHR service is missing or the code and modifier decision is unresolved, sending the claim through another clearinghouse does not solve the source problem. It adds a second filing path and creates more duplicate-claim and reconciliation risk. Correct and verify the source first; if that cannot be done safely, hold the claim for review.

Reimbursement Rates Are a Separate Question

Highmark’s coding update does not publish one universal reimbursement amount for each 980xx code. A payable rate can depend on the exact contract, network, clinician or provider tier, date, and other terms. The amount a payer allows is also different from the billed fee configured in the EHR.

Do not use an unverified amount as either a contracted allowance or an EHR fee. Obtain authoritative rate documentation at the correct contract and network grain. A missing rate does not prove that the CPT is invalid, and recognition of the CPT does not prove what it will pay.

Provider Checklist

1. Identify Highmark Commercial versus Medicare Advantage from the member’s actual coverage.

2. Apply the rule by date of service and region—not by submission date or payer name alone.

3. Document audio-video versus audio-only modality and whether the patient was at home.

4. Use authoritative coding guidance rather than inventing a 992xx-to-980xx crosswalk.

5. Review each claim line separately, including psychotherapy companions and modifiers.

6. Correct the EHR source, verify readback, refresh downstream billing data, and only then create the final claim.

7. Validate the exact claim without transmitting when the payer or EHR allows a preview.

8. Confirm reimbursement from authoritative contract and rate evidence separately.

A Note for Practices Using Bomi

Bomi is implementing exact recognition of CPT 98000–98015 and a source-first SimplePractice workflow. When finalized, an applicable correction will update the actual SimplePractice line, verify readback, refresh Bomi’s mirror, and then assemble and submit through SimplePractice with line-specific preservation. Bomi will not use Stedi as a fallback for missing setup or uncertain coding.

That implementation is still in progress and is not live or finalized. Bomi will not activate the reported 992xx-to-980xx conversions or exact 980xx modifier behavior until authoritative guidance resolves the current ambiguity. Reimbursement rates remain separate and unresolved.

Frequently Asked Questions

When did Highmark’s Commercial 980xx telehealth change take effect?

Highmark states that CPT 98000–98015 became effective September 1, 2026 for providers in Pennsylvania, Delaware, and West Virginia. Highmark says its New York regions adopted the codes in 2025.

Does the Highmark change apply to Medicare Advantage?

The announced 980xx adoption is for Highmark Commercial plans. Highmark says Medicare Advantage continues to follow CMS telehealth guidance, so providers should not apply the Commercial rule based on the payer name alone.

Should every Highmark telehealth 992xx claim be changed to 980xx?

Not based on the public materials alone. They permit the 980xx family but do not clearly publish a mandatory one-to-one 992xx-to-980xx crosswalk. Select the code from the documented service and authoritative coding guidance.

Do psychotherapy services change to 980xx?

No—not merely because they were delivered by telehealth. The 980xx family describes telehealth E/M services. Psychotherapy and psychotherapy add-on services retain their own CPT codes and need separate line-specific modifier review.

Which POS should a Highmark telehealth claim use?

Highmark directs professional claims to POS 02 when the patient receives telehealth outside the home and POS 10 when the patient receives it in the home.

Which modifier should providers use with Highmark 980xx?

Highmark’s public materials include broad telehealth-modifier guidance but do not yet clearly settle the exact line-level treatment for every 980xx scenario. Verify current payer and coding guidance rather than automatically carrying forward or removing a modifier.

Did Highmark publish final reimbursement rates for 980xx?

The coding announcement does not establish one universal rate. Confirm reimbursement separately for the exact contract, network, provider tier, and effective date, and do not confuse an allowed amount with the billed fee in the EHR.

Bottom Line

Highmark Commercial now permits the 98000–98015 telehealth E/M family for the stated scope, effective September 1, 2026 in Pennsylvania, Delaware, and West Virginia. Providers still need to distinguish Commercial from Medicare Advantage, choose the code that reflects the actual service and modality, use POS 02 or 10 based on patient location, and treat modifiers line by line.

The public materials do not yet clearly prove a mandatory 992xx-to-980xx crosswalk or the exact modifier treatment for every 980xx claim. Correct the source, preserve unrelated line details, validate before filing, and keep reimbursement-rate work separate from the coding decision.

Scope note: This article summarizes Highmark’s public materials as of September 10, 2026. It is educational, not coding, legal, coverage, or reimbursement advice. Verify the member’s plan and current payer guidance before filing.

Sources

• Highmark: Telehealth Policy Will Be Updated on Sept. 1

• Highmark Reimbursement Policy RP-046 preview, version effective September 1, 2026

• AMA: Digital Medicine Clinical Scenarios and Coding Handbook

• SimplePractice: Creating and using service codes