# Audio Only Mental Health Telehealth Rules: Medicare and Texas Medicaid, 2026 to 2028

> Medicare pays audio only therapy at home with modifier 93 and POS 10 through 2027. Texas Medicaid needs FQ and a prior visit within 6 months.

Source: https://webillhealth.com/audio-only-telehealth-mental-health-rules/  
Publisher: WeBill Health  
Last updated: November 13, 2026

Audio only mental health telehealth is billable to Medicare through December 31, 2027 for a patient at home who cannot use or declines video, using modifier 93 and place of service 10, with no in person visit required. Texas Medicaid pays phone therapy too, but it requires modifier FQ and a video or in person visit within six months before the first phone session.

One phone session, two claims. Sample claim for illustration, rules checked November 13, 2026.

## When does Medicare pay for audio only therapy?

Medicare pays audio only telehealth when the patient is at home, the practitioner is able to use video, and the patient is not capable of video or does not consent to it. That is the condition written into 42 CFR 410.78(a)(3), and the CMS Telehealth FAQ updated October 8, 2026 confirms that beneficiaries can keep receiving audio only telehealth at home through December 31, 2027.

The rule covers new and established patients. It applies to the services on the Medicare Telehealth Services List, which includes psychiatric diagnostic evaluation and the psychotherapy codes.

## Which modifier goes on an audio only claim: 93 or FQ?

Medicare professional claims carry CPT modifier 93, and rural health clinics and FQHCs use Medicare modifier FQ, as 42 CFR 410.78(a)(3) lists. Texas Medicaid uses FQ for outpatient mental health by phone. Check the payer’s own rule before choosing the modifier, because the same session needs a different one for each payer.

| Payer | Audio only modifier | Video claim marker | Source |
|---|---|---|---|
| Medicare, professional claim | 93 | POS 02 or 10 identifies telehealth | 42 CFR 410.78; CMS Telehealth FAQ, Oct 8, 2026 |
| Medicare, RHC or FQHC | FQ | Follow your MAC instructions | 42 CFR 410.78(a)(3) |
| Texas Medicaid, outpatient mental health | FQ | 95 | TMPPM Behavioral Health Handbook, Nov 2026, 4.2.1.1 and 4.2.1.2 |

## Which place of service code applies, 02 or 10?

Use POS 10 when the patient is in their home and POS 02 when the patient is somewhere else, such as a clinic. The CMS Telehealth FAQ gives that split in its place of service answer. Most audio only therapy happens with the patient at home, so most of these claims carry POS 10.

## Do I need an in person visit before billing audio only therapy?

Medicare does not require one for services furnished through December 31, 2027. Texas Medicaid does. Its handbook requires at least one in person or video service within the six months before the first phone session, states that this requirement may not be waived, and then requires an in person or video service every rolling 12 months.

That difference matters for Texas practices. A new Medicaid patient whose first contact is a phone call does not meet the Texas rule, even though the same call would pay under Medicare.

## What changes for Medicare on January 1, 2028?

The in person requirement for mental health telehealth starts for services after December 31, 2027. A new patient then needs an in person, non telehealth visit within six months before the first mental health telehealth service. A patient who started mental health telehealth at home on or before December 31, 2027 counts as established and needs an in person visit at least every 12 months.

Two relief valves stay in the rule. The 12 month visit can be skipped for a given year when the practitioner and patient agree the risks and burdens outweigh the benefit and the reason is documented, and a practitioner of the same specialty in the same group can furnish the in person visit when the treating practitioner is unavailable.

Audio only itself continues for behavioral health at home in 2028, for new and established patients, under the same video capable condition.

## What must the chart note show for an audio only session?

The note needs the reason video was not used, the patient’s location, start and stop time for time based codes, and the content of the session. Medicare’s condition is that the patient could not use or did not consent to video. Texas Medicaid requires the reason for phone delivery in the medical record and the patient’s agreement to it.

A note that says only “telehealth” with no modality gives a reviewer nothing to support modifier 93 or FQ.

## Which codes can be delivered by phone under Texas Medicaid?

Texas Medicaid allows psychiatric diagnostic evaluation (90791, 90792), the psychotherapy codes, and psychiatric pharmacological management billed as E/M with modifier UD by phone. Neurobehavioral status exams and psychological or neuropsychological testing are listed for video delivery only, so they cannot be billed with FQ.

## What new Medicare modifiers start in 2027?

Modifiers BB and BC are required on Medicare telehealth claims beginning January 1, 2027. The CMS FAQ says BB applies when the service is furnished through a virtual platform the practitioner has a contract or payment arrangement with, and BC applies to telehealth furnished incident to a professional service. CMS states they do not change payment, but a missing modifier is still a claim defect.

## WeBill Health take

WeBill Health maintains internal payer rule libraries organized by specialty and by carrier, built by people who work behavioral health claims every day, and every claim receives human pre submission review against them before it goes out. For telehealth, that review checks the modifier against the payer, the place of service against the patient location, and the Texas six month rule before a phone session is billed.

## Audio only telehealth billing FAQ

### Can I bill Medicare for audio only therapy in 2026?

Yes. Through December 31, 2027, Medicare pays audio only telehealth to a patient at home when the practitioner can offer video and the patient cannot use it or does not consent to it. Bill the service with modifier 93 and place of service 10, and record why video was not used.

### Is modifier 93 or FQ used for audio only mental health?

It depends on the payer. Medicare professional claims use CPT modifier 93, with FQ for rural health clinics and FQHCs, under 42 CFR 410.78. Texas Medicaid requires FQ on outpatient mental health services delivered by phone, according to the November 2026 Behavioral Health and Case Management Services Handbook.

### Does Medicare require an in person visit before telehealth therapy?

Not for services furnished through December 31, 2027. Starting January 1, 2028, a new patient needs an in person visit within six months before the first mental health telehealth service. Patients who began mental health telehealth at home on or before December 31, 2027 are treated as established and need an in person visit every 12 months.

### What happens to audio only telehealth in 2028?

From January 1, 2028, the CMS Telehealth FAQ says audio only stays available for behavioral health services in the patient’s home, for new and established patients, when the practitioner can use video and the patient cannot or declines. The broader audio only allowance for other services runs through December 31, 2027.

[Request a Revenue Defense Audit](https://webillhealth.com/revenue-defense-audit/) to see which of your telehealth claims are at risk before the 2028 rules start.

Related: [Telehealth billing rules for mental health providers](https://webillhealth.com/what-are-the-telehealth-billing-rules-for-mental-health-providers-in-2026/), [Telehealth billing denials in mental health](https://webillhealth.com/telehealth-billing-denials-mental-health/), [Psychiatry billing](https://webillhealth.com/technical-revenue-advocacy-for-psychiatry-2/).

## Sources

* [CMS, Telehealth FAQ, updated October 8, 2026](https://www.cms.gov/files/document/telehealth-faq-updated-10-09-2026.pdf)
* [42 CFR 410.78, Telehealth services (eCFR, current as of October 22, 2026)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.78)
* [Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, November 2026](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-11-november/2_02_behavioral_health.pdf)
* [HHS, CMS finalizes CY 2027 Physician Fee Schedule, November 4, 2026](https://www.hhs.gov/press-room/cms-finalizes-2027-medicare-physician-fee-schedule.html)

WeBill Health is a specialty focused revenue cycle management partner for independent practices. Request a Revenue Defense Audit at https://webillhealth.com/form/