Beginning September 1, 2026, telehealth claims billed with Place of Service (POS) 02 or POS 10 will be subject to the same ICD-10-CM Excludes1 editing rules currently applied to other claim types. This update extends existing ICD-10-CM coding standards to telehealth claims to support consistent claims processing. Claims submitted with diagnosis code combinations prohibited by an Excludes1 note may not be eligible for reimbursement. Member benefits and telehealth coverage remain unchanged by this update.

To support accurate claims processing, care providers should:

• Review ICD-10-CM Excludes1 notes before submitting telehealth claims.
• Verify that diagnosis codes reported together are not prohibited by an Excludes1 convention.
• Code to the highest level of specificity and ensure documentation supports the selected diagnosis.

Excludes1 notes and telehealth claims

Excludes1 notes identify diagnosis code combinations that should not be reported together. As you document and code telehealth services, review Excludes1 notes before submitting claims. For example, Z01.419 (gynecological examination without abnormal findings) and Z12.4 (screening for malignant neoplasm of the cervix) may not be reported together because of an Excludes1 note. Care providers should select diagnosis codes that accurately reflect the services performed and the supporting documentation.

Questions or disputes

If you believe an Excludes1-related claim outcome does not align with ICD-10-CM coding guidance, verify the guidance in the current ICD-10-CM code set and submit a dispute through the standard process. Most disputes can be submitted electronically via https://Availity.com or in writing using the Provider Dispute Resolution Form. Include relevant claim details and supporting documentation for review and use the Availity Appeals Dashboard to upload materials and track the status. For questions about this update, please contact your provider relationship management representative.