TEAM, Telehealth and New HCPCS Codes
Key Takeaways
The CMS Transforming Episode Accountability Model (TEAM) is a mandatory, five-year episode-based payment model running from 2026–2030 for selected acute care hospitals.
TEAM episodes are triggered by specific MS-DRGs and HCPCS codes across five surgical categories, including joint replacement, spinal fusion, CABG, hip or femur fracture, and major bowel procedures.
Each TEAM episode bundles all related Medicare Part A and Part B services from the procedure through 30 days post-discharge into a single, risk-adjusted target price.
Telehealth services are allowed during TEAM episodes when billed by the participating hospital and reported using new TEAM-specific HCPCS G-codes effective January 1, 2026.
Hospitals can earn additional CMS payments or owe repayments based on episode spending performance and quality outcomes.
Transforming Episode Accountability Model – TEAM is a new initiative from CMS in use by selected acute care hospitals to coordinate patient care from the day of surgery through 30 days post hospitalization. This new model of patient care is aimed at providing care for people with original Medicare who have had one of the following five surgical procedures:
Lower extremity joint replacement,
Surgical hip femur fracture treatment,
Spinal fusion,
Coronary artery bypass graft
Major bowel procedures.
Team is a mandatory model and will run for 5 years from January 1, 2026, to December 31, 2030, in designated Core-Based Statistical Areas nationwide. CMS defines a Mandatory model as follows:
Mandatory model: A CMS Innovation Center model (pilot program) that requires a defined set of eligible participants to take part; participants do not generally have an option to leave the model before testing is completed.
The premise from the CMS innovation center is that patients with Original Medicare undergoing a surgical procedure either in the hospital or as an outpatient may experience fragmented care that can lead to complications in recovery, avoidable hospitalization, and other high costs. This program is aimed at cost containment by avoiding rehospitalization and emergency room visits through better continuity of care.
The model uses an episode – based approach, issuing a lump sum payment to cover all costs associated with an episode of care. The episode-based payment will include all costs associated with the cost for the inpatient or outpatient stay/procedure and all services following hospital discharge, to include skilled nursing facility stays or provider follow-up visits.
Episodes will begin on the date of a person’s hospital inpatient stay or hospital outpatient procedure for one of the surgical procedures listed above. Each episode will end 30 days after the individual leaves the hospital. CMS instructs TEAM participants to continue to bill Medicare FFS as usual. Providers will receive target prices for included episodes prior to each performance year. According to CMS: “Target prices will be based on all Medicare Parts A & B (both facility and professional) items and services included in an episode and will be risk-adjusted based on beneficiary-level and hospital-level factors.” TEAM (Transforming Episode Accountability Model) | CMS
In TEAM, submitting a claim for either an inpatient stay that includes 1 of the Medicare Severity Diagnosis-Related Groups (MS-DRGs) or an outpatient procedure claim that contains 1 of the HCPCS codes CMS identified in 42 CFR 512.525(d) initiates an episode. Each episode will end on the 30th day following the date of the anchor procedure or the date of discharge from the anchor hospitalization.
Episode categories. The MS-DRGs and HCPCS codes included in the episodes are as follows:
(1) Lower Extremity Joint Replacement (LEJR):
(i) IPPS discharge under MS-DRG 469, 470, 521, or 522; or
(ii) OPPS claim for HCPCS codes 27447, 27130, or 27702.
(2) Surgical Hip/Femur Fracture Treatment (SHFFT). IPPS discharge under MS-DRG 480 to 482.
(3) Coronary Artery Bypass Graft Surgery (CABG). IPPS discharge under MS-DRG 231 to 236.
(4) Spinal Fusion:
(i) IPPS discharge under MS-DRG 402, 426, 427, 428, 429, 430, 447, 448, 450, 451, 471, 472, 473; or
(ii) OPPS claim for HCPCS codes 22551, 22554, 22612, 22630, or 22633.
(5) Major Bowel Procedure. IPPS discharge under MS-DRG 329 to 331.
Each episode cost includes all items and services related to the hospital inpatient stay or outpatient procedure and all non-excluded Medicare Part A and Medicare Part B items and services for 30 days following discharge, such as: Follow-up care in skilled nursing facilities, Outpatient visits, and Physician services.
See 42 CFR 512.525(e) and 42 CFR 512.525(f) for a list of items and services included and excluded from an episode.
Patients in any geographic area may receive Telehealth services during a Team Episode. These will be paid for telehealth services rendered to a discharged patient during a Team episode who are at home or other place of residence. The following directives are found on page 5 of MLN Matters - MM14225 and are related to Change request – CR 14215 effective January 1, 2026:
“A participating hospital must have discharged the patient who is receiving telehealth services for one of the TEAM episode MS-DRGs or HCPCS codes
You must provide the telehealth services within 30 days after the patient receives an outpatient procedure or leaves the hospital
The participating hospital must bill for the telehealth services
Telehealth services cannot replace in-person home health visits for patients under a home health episode of care
We will not cover telehealth services performed by social workers for patients under a home health episode of care
The telehealth geographic waiver and allowing the home as an originating site do not apply when a physician or approved non-physician practitioner conducts a face-to-face visit to certify patient eligibility for the Medicare home health benefit
If the patient is at home, you cannot provide a telehealth service with a descriptor that prevents delivering the service in a home (for example, a hospital visit code)
If you provide an E/M visit through telehealth to a patient at home, you must bill the visit using 1 of the TEAM-specific G codes listed in Business Requirement 28 of this CR, which corresponds to different levels of time-based E/M services.”
The new HCPCS codes active on January 1, 2026, are as follows:
G0660 TEAM Remote E/M new pt 10mins 99201
G0661 TEAM Remote E/M new pt 20mins 99202
G0662 TEAM Remote E/M new pt 30 mins 99203
G0663 TEAM Remote E/M new pt 45mins 99204
G0664 TEAM Remote E/M new pt 60mins 99205
G0665 TEAM Remote E/M est. pt 10mins 99212
G0666 TEAM Remote E/M est. pt 15mins 99213
G0667 TEAM Remote E/M est. pt 25mins 99214
G0668 TEAM Remote E/M est. pt 40mins 99215
mm14215_new.pdf, r13479demo.pdf pg. 13
In regard to telehealth requirements, “CMS waives the geographic site requirements of section 1834(m)(4)(C)(i)(I) through (III) of the Act for episodes being tested in TEAM solely for services that—
(i) May be furnished via telehealth under existing Medicare program requirements; and
(ii) Are included in the episode in accordance with § 512.525(e).” eCFR :: 42 CFR Part 512 Subpart E -- Transforming Episode Accountability Model (TEAM)
CMS will assess performance in the model by comparing the participants’ actual Medicare FFS spending for the episode to their target price, as well as through an assessment of performance on specific quality measures. TEAM participants can earn additional payment from CMS, subject to a quality performance adjustment, if the total Medicare costs for the episode are below the target price. Conversely, TEAM participants may owe CMS a repayment amount, subject to a quality performance adjustment, if the total Medicare costs for the episode are above the target price. See 42 CFR 512.540, 42 CFR 512.545, and 42 CFR 512.550 for additional information on TEAM’s pricing and payment methodology.
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