September 2026 is increasingly a documentation, provider-response and payer-compliance month. AM Med
Solutions manages credentialing, contracting, payer enrollment follow-up, coding review, claim submission
and related revenue-cycle functions for our clients. Many payer and Medicaid requirements, however, still
depend on timely participation from the practice and provider.

• Respond quickly to AM Med requests for signatures, attestations, ownership information, licenses,
service-location confirmations, banking information, CAQH confirmations or other enrollment
documents.
• Document diagnoses with the greatest clinical specificity supported by the patient’s actual condition.
• Document pediatric preventive services, vaccine counseling and separately managed problems
clearly.
• Support behavioral-health, longitudinal-care and SDOH documentation when clinically appropriate.
• Provide requested clinical records or clarification promptly when AM Med is handling an authorization,
reconsideration, appeal or payer review.

When clinically applicable, providers should document laterality; acute versus chronic status; severity;
controlled versus uncontrolled status; complications; exact anatomical location; associated manifestations;
recurrence; episode of care; and relevant disease stage.

• Modifier 95: Synchronous telemedicine furnished through real-time interactive audio and video.
• Modifier 93: Synchronous telemedicine furnished through telephone or another real-time interactive
  audio-only system.

These are not new general modifiers for 2026, and payer requirements remain plan-specific. AM Med will
determine the appropriate modifier and place of service based on the payer and service.

For Medicare dates of service beginning October 1, 2026, RHCs and FQHCs must report the individual CPT or
HCPCS code describing an applicable distant-site telehealth service instead of reporting only G2025. The
appropriate revenue code must be reported with modifier 95 for qualifying audio-video services or modifier 93
for qualifying audio-only services.

WHAT PROVIDERS SHOULD DO: Clearly identify whether the encounter was audio-video or
audio-only and document the clinical service completely. AM Med will handle the claim-format
and billing changes.

Medicare added several services to its telehealth list for 2026, including multiple-family group psychotherapy,
group behavioral counseling for obesity, an infectious-disease add-on service and certain auditory
osseointegrated sound-processor services. CPT also added several existing services—primarily behavioral
health services—to Appendix P for audio-video delivery and Appendix T for audio-only delivery. Inclusion does
not guarantee payment by every payer; AM Med will verify payer-specific coverage.

The CPT telemedicine E/M family 98000–98016 was introduced previously, effective January 1, 2025. It is not a
new late-2026 code family, and payer adoption varies. Practices should not automatically replace
office/outpatient E/M codes with 98000–98016. AM Med will apply the code set recognized by the patient’s
payer.

• 98979: RTM treatment-management services, first 10 minutes in a calendar month, including the
required real-time interactive communication.
• 98984: Respiratory-system RTM device supply for 2–15 days in a 30-day period.
• 98985: Musculoskeletal-system RTM device supply for 2–15 days in a 30-day period.

The descriptors for 98976 and 98977 were revised for 16–30 days. When RTM is furnished under a therapy plan
of care, applicable therapy modifiers and supervision rules may also apply.

CMS has proposed transitioning G2211 to a new two-character HCPCS modifier that would increase the
associated E/M payment by 16%. CMS also proposed a separate modifier for qualifying ACO practitioners that
would increase the associated E/M payment by 32%. CMS currently refers to these as placeholder MOD1 and
MOD2. They are proposals—not active modifiers—and must not be submitted unless CMS finalizes the policy
and publishes the official modifier values.

FQHC billing differs materially from ordinary professional billing. AM Med will manage the encounter, revenue
code, PPS, payer and claim requirements for participating clients. Providers should focus on documenting the
qualifying encounter and immediately communicating operational or clinical changes that affect enrollment,
scope or reimbursement.

The 2026 Medicare FQHC PPS base payment rate is $207.72 before the applicable geographic adjustment, a
2.5% increase from 2025. Medicare generally pays the lesser of the FQHC’s actual charges or the adjusted
PPS rate for qualifying FQHC services furnished on the same day as a medically necessary FQHC visit. AM Med
will apply the appropriate PPS and claim rules.

• A medically necessary encounter with an eligible FQHC practitioner and the reason for the visit.
• The patient’s condition, relevant history and findings, assessment, treatment and follow-up plan.
• Whether services occurred in person, by audio-video telehealth or by audio-only telehealth.
• Time when a service is time-based and the identity and role of each participating practitioner or clinical
staff member.
• Separate medical, mental-health or dental encounters on the same day when payer rules may permit
more than one payment, with distinct medical necessity and documentation.
• Referrals, orders, care coordination and outside records supporting services furnished by the health
center.

Beginning October 1, 2026, Medicare FQHCs must report the specific CPT or HCPCS code for an applicable
distant-site telehealth service instead of reporting only G2025. Modifier 95 identifies qualifying audio-video
services and modifier 93 identifies qualifying audio-only services. Providers should clearly document the
technology used; AM Med will handle claim configuration and submission.

For 2026, Medicare’s FQHC IOP payment rate is $319.38 for three or fewer qualifying services per day and
$418.45 for four or more. Providers participating in an IOP should document the covered condition,
individualized treatment plan, services furnished, clinical staff involved, time or units when applicable, patient
participation and progress.

Dental FQHC coverage is highly payer- and state-specific. Medicaid programs and managed-care dental plans
may cover preventive, diagnostic, restorative, surgical and other services under different encounter and fee
schedule rules. Dental teams should document the tooth or oral structure, diagnosis, surfaces or quadrants
when relevant, clinical findings, imaging, procedure performed, materials, anesthesia, medical necessity,
treatment plan and follow-up.

MEDICARE DENTAL CAUTION: Original Medicare generally excludes routine dental care.
Coverage may exist when dental services are inextricably linked to the clinical success of
another covered Medicare service. Do not assume that providing dental care in an FQHC
makes it Medicare-covered.

CMS identifies limited circumstances in which medically necessary dental or oral examinations and treatment
may be covered because they are integral to another covered service. Examples include certain services
connected with organ or stem-cell transplantation, cardiac valve procedures, treatment of head and neck
cancer, chemotherapy or CAR-T therapy, high-dose antiresorptive therapy for cancer, and ESRD dialysis.
Coverage depends on the exact facts and current Medicare requirements.

When dental coverage depends on being inextricably linked to a covered medical service, the record must
demonstrate coordination between the dentist and the medical practitioner. Providers should retain the
referral or exchanged clinical information, identify the covered medical service, explain why the dental service
is necessary for its clinical success and document the timing of the dental treatment. Without documented
coordination, Medicare may deny coverage.

Notify AM Med before adding or terminating medical, behavioral-health or dental practitioners; adding dental
services; changing scope of project; opening, closing or relocating a site; changing hours, ownership, tax
information or service lines; or changing an FQHC location identifier. These changes may affect HRSA scope,
Medicare and Medicaid enrollment, managed-care credentialing, provider directories and claim payment.

Over the coming months, practices should expect continued movement toward electronic prior authorization,
tighter Medicaid eligibility verification, increased enrollment oversight, stronger interoperability, evolving
vaccine guidance and a gradual shift toward value- and outcome-based reimbursement.

As of September 1, 2026, all new Oscar prior-authorization requests must be submitted through Availity
Essentials™. Practices should make sure they are registered and properly set up on Availity Essentials now to
avoid delays in authorization and patient care.

WHAT THE PRACTICE SHOULD DO: Confirm that the appropriate staff have active Availity
Essentials access and promptly provide AM Med with any clinical records, orders or supporting
documentation required for the authorization. AM Med will manage the payer-facing
authorization process when included in the client’s contracted services.

Oscar now requires taxonomy codes on all claims. Both the billing provider and rendering provider taxonomy
codes must be included when applicable. Missing or incorrect taxonomy information may delay claim
processing or cause a rejection or denial.

AM MED ACTION: AM Med will update applicable Oscar claim-submission settings to include
billing and rendering provider taxonomy codes. Practices should promptly confirm each
provider’s current specialty and taxonomy and notify AM Med before adding a provider or
changing a provider’s specialty, enrollment or service location.

Some adult Medicaid populations may face more frequent eligibility checks and new requirements. Pediatric
practices may still see household coverage changes, new member IDs and plan changes. Front-office staff
should capture current insurance information and promptly send updates to AM Med.

Affected payers are moving toward required prior-authorization APIs in 2027. Providers should document
diagnosis, severity, prior treatment or failure, clinical findings and the reason the requested service is
medically necessary. AM Med will manage the payer-facing process where included in the client’s services.

CMS proposed changes to 2027 physician payment, including conversion-factor adjustments. The rule was
not final as of this publication date. AM Med will monitor the final rule and assess client impact.

CMS proposed replacing the current flat add-on approach with percentage-based E/M payment adjustments.
This remains a proposal. Providers should continue documenting the longitudinal nature of care; AM Med will
determine appropriate billing after final rules are issued.

Payer review is shifting earlier in the care cycle. Strong documentation before a service—rather than after a
denial—will become increasingly important.

AAP and federal vaccine guidance, payer coverage and VFC rules may evolve during fall 2026 and early 2027.
Providers should follow current clinical guidance and document counseling, administration, refusals and
deferrals; AM Med will monitor coding and reimbursement implications.

Medicare proposals may affect remote patient and therapeutic monitoring. Practices should avoid assuming
that today’s reimbursement will remain unchanged when developing future programs.

CMS continues moving toward electronic interoperability, quality measurement and value-based
reimbursement, including a longer-term transition toward MIPS Value Pathways.

CMS initiatives increasingly connect technology-supported chronic-care management with measurable
outcomes. This direction may create new opportunities, but clinical workflows and documentation must
precede billing.

AM MED COMMITMENT: We will monitor final rules, payer bulletins, credentialing and
revalidation deadlines, coding and reimbursement changes, prior-authorization requirements
and other RCM developments. When practice action is required, AM Med will communicate
what is needed and assist with the process.

• Respond promptly to AM Med credentialing and contracting requests.
• Notify AM Med before adding or terminating providers or changing locations, ownership or
organizational information.
• Document diagnoses with the greatest supported clinical specificity.
• Clearly document additional problems addressed during preventive visits.
• Document vaccine counseling and preventive services completely.
• Document behavioral-health treatment plans, longitudinal care and clinically relevant SDOH factors.
• Provide requested records quickly when AM Med is handling an authorization, appeal, reconsideration
or payer review.
• Send a referral

Depending on the client’s contracted services, AM Med Solutions manages credentialing; recredentialing;
payer enrollment; contracting and contract follow-up; coding review; claim preparation and submission; payer
follow-up; denial management; payment posting; accounts-receivable follow-up; payer-policy review;
reconsiderations; appeals; and related revenue-cycle functions.

BOTTOM LINE: We are here to help you succeed. Do you know of anyone who can use our
help?

CMS — Interoperability and Prior Authorization Final
Rule (cms.gov)
CMS — Therapy Code List: 2026 Annual Update,
MM14250 (cms.gov)
HRSA — Health Center Program Compliance Manual
and Scope of Project Policy Manual (hrsa.gov)
New York Medicaid Update — Provider Revalidation
(health.ny.gov)
South Carolina Medicaid — Provider Revalidation
(scdhhs.gov)