Every claim denial for a telehealth visit is a direct hit to your practice’s bottom line. With virtual care now a permanent fixture, optimizing your billing process is more critical than ever. The key to preventing lost revenue lies in mastering the new telehealth billing codes that are set to roll out. These codes are designed to let payers reimburse virtual visits differently than in-person appointments, which can significantly impact your cash flow if you’re not prepared. This guide breaks down how these codes work, how they differ across payers like Medicare and commercial insurers, and how you can ensure your claims are clean, compliant, and paid correctly the first time.
Key Takeaways
- Master the telemedicine code shift, but remember Medicare’s exception: While many commercial payers have adopted the new 98000-series telehealth codes, Medicare has not (aside from 98016). To prevent automatic denials, continue using standard E/M codes with the correct telehealth modifier (like 95 or 93) for all your Medicare claims.
- Confirm telehealth policies with every single payer: There is no universal standard for telehealth billing, and rules vary widely. Make it a non-negotiable step to verify each insurer’s preferred codes and coverage requirements before the virtual visit to ensure clean claims.
- Your documentation is your best defense: Your notes must justify the service and modality used. For audio-only calls, it’s crucial to document why video wasn’t an option. This level of detail protects your practice in an audit and is key to getting paid correctly.
What Are Telehealth Billing Codes?
Think of telehealth billing codes as the specific language you use to tell insurance companies exactly what kind of virtual care you provided. Just like in-person visits have their own set of CPT codes, telehealth services require unique codes to describe the encounter accurately. For years, especially during the public health emergency, billing for telehealth involved a patchwork of temporary rules and modifiers. That’s all changing.
Effective January 1, 2025, CPT introduced a permanent set of telemedicine codes — 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, and 98016 — specifically for telehealth. The goal of these codes is to create a clear distinction between services delivered virtually and those provided face-to-face. This shift away from temporary regulations means your practice needs a solid grasp of the new system to ensure your medical billing is clean and compliant. Using the correct code ensures that you communicate the value of your service accurately and get paid appropriately for the care you deliver remotely.
Why These Codes Are Crucial for Your Practice
Telehealth became a lifeline for many practices during the COVID-19 pandemic, and temporary regulatory flexibility made it easier to implement quickly. As we move into a more permanent telehealth landscape, understanding the new coding structure is non-negotiable for compliance and reimbursement. Using outdated or incorrect codes can lead to claim denials, audits, and lost revenue. It’s essential for providers to stay informed and regularly check the latest list of covered services, as payers like Medicare are continuously updating their policies. Getting this right from the start protects your practice and ensures you can continue offering valuable virtual care to your patients.
How They Impact Your Revenue Cycle
The new telehealth codes directly influence your practice’s bottom line. They are specifically designed to allow insurance companies to reimburse telehealth services differently than in-person visits, which can have a major effect on your revenue. A code for a video visit might pay differently than one for an audio-only call or a traditional office appointment. To maintain a healthy revenue cycle, you must closely monitor the reimbursement rates for these new codes. Accurate coding and diligent follow-up are key to ensuring you receive fair payment for your services. This is where expert practice management consulting can make a significant difference by helping you analyze and optimize your billing processes.
Essential Telehealth Billing Codes for 2026
Keeping up with telehealth billing can feel like a moving target, and recent code cycles have brought significant changes. The temporary rules put in place during the pandemic have been replaced with a more permanent structure. Understanding these new codes is absolutely essential for maintaining a healthy revenue cycle and ensuring you get paid correctly for the virtual care you provide. Getting this right from the start will save you countless headaches from claim denials and audits down the road. Let’s walk through exactly what you need to know.
A Look at New CPT Codes for Virtual Services
CPT now includes a dedicated set of telemedicine codes, the 98000 series (98000 through the audio-only and check-in codes listed below), designed to create a standardized system for billing virtual services. These codes officially replace the temporary, often confusing, guidelines that practices have been using for the past few years. This shift is meant to bring more clarity and consistency to telehealth billing across different payers. Think of it as a fresh start, giving you a dedicated set of tools to accurately report the virtual visits you conduct. You can find more details on the new 2025 telehealth CPT codes from official sources to prepare your team.
Audio-Video vs. Audio-Only: Key Coding Differences
The new codes are divided into two main categories based on the technology used. Codes 98000, 98001, 98002, 98003, 98004, 98005, 98006, and 98007 are for telehealth visits that include both audio and video, which is the most common type of virtual appointment. For visits that are audio-only, like a standard phone call, you’ll use codes 98008, 98009, 98010, 98011, 98012, 98013, 98014, and 98015. A key requirement for billing an audio-only service is that at least 10 minutes of the call must be a medical discussion with the patient or their caregiver. This distinction is crucial for compliance and proper reimbursement, making accurate medical billing more important than ever.
Using E/M Codes and Modifiers for Medicare
Here’s the most important exception you need to be aware of: Medicare will not be using the new 98000-series telehealth codes. Instead, Medicare has stated it will continue with its existing method. For telehealth visits with Medicare patients, you will keep using the standard office visit E/M codes (99202, 99203, 99204, 99205, and 99212, 99213, 99214, 99215) and append the appropriate telehealth modifier, such as 95 for audio-video visits or 93 for audio-only. This is a major difference in policy that can easily lead to claim denials if your team isn’t prepared. Managing these payer-specific rules is a common challenge for many healthcare providers we work with.
How Telehealth Codes Differ From In-Person E/M Codes
While the principles of evaluation and management (E/M) coding are similar for both telehealth and in-person visits, the specific rules are not identical. The shift to permanent telehealth codes brings a new set of requirements that directly impact how you document services and what you get paid. Understanding these distinctions is key to maintaining a healthy revenue cycle and staying compliant. The main differences fall into three categories: how the service is delivered, what your documentation needs to include, and how payers calculate reimbursement for virtual care. Getting these details right ensures you’re coding accurately for the excellent care you provide, whether it’s in the office or through a screen.
Service Delivery Requirements
The permanent 98000-series telemedicine codes replaced the temporary conventions used during the public health emergency. The good news is that selecting the right code follows a familiar logic. Just like with standard office visits, your choice will be based on either the complexity of medical decision-making (MDM) or the total time spent with the patient. This framework provides a consistent approach, making the transition smoother for your practice. The key is to recognize that these are now dedicated telehealth codes and must be used for services delivered virtually, distinguishing them from their in-person counterparts.
Documentation Standards for Telehealth
Your clinical notes for a telehealth visit need to tell the full story, and the requirements can be more specific than for in-person encounters. For audio-only visits, for instance, you must document that at least 10 minutes of the call were dedicated to medical discussion. This rule doesn’t apply to visits with both audio and video. It’s also critical to document why an audio-only visit was necessary. Your notes should clearly state that video technology was available, but the patient either couldn’t use it or preferred not to. Proper telehealth documentation is your best defense in an audit and ensures you meet payer requirements.
Understanding the Differences in Payment
It’s important to set realistic expectations for telehealth reimbursement. While the physician work component is valued similarly to in-person services, the total payment is often lower. This is because the practice expense (PE) component—which covers costs like rent, supplies, and clinical staff—is reduced for virtual visits. Payers reimburse less for audio/video services compared to in-person care, and even less for audio-only calls. These new codes are designed to give payers the flexibility to set different rates for telehealth. This makes it more important than ever to verify reimbursement policies with each payer and manage your medical billing with precision.
Which Modifiers and Place of Service Codes Do You Need?
Getting your telehealth billing right often comes down to the details, and that’s where modifiers and Place of Service (POS) codes come in. Think of them as specific tags you add to your claims that tell the insurance company exactly how and where you provided care. Using the correct codes is essential for clean claims and timely reimbursement. Without them, you risk denials and delays that can disrupt your revenue cycle.
Getting these codes right is a key part of effective practice management. Let’s walk through the most common modifiers and POS codes you’ll need for your telehealth services so you can bill with confidence.
Key Telehealth Modifiers (95, 93, GT, GQ)
Modifiers add crucial context to your CPT codes, specifying the type of technology used during a virtual visit. Each one tells a slightly different story, so picking the right one is key.
Here are the main telehealth modifiers you’ll encounter:
- Modifier 95: This is one of the most common modifiers. Use it for services delivered through synchronous, real-time audio and video communication. Essentially, if you and your patient can see and hear each other live on a video call, this is the modifier you’ll likely use.
- Modifier 93: This modifier is for synchronous audio-only services. If you conduct a patient visit over the phone without a video component, Modifier 93 is the one to use.
- GT Modifier: This modifier also signifies a service was provided via live audio and video. It’s most often used for institutional claims, but some commercial payers may still require it.
- GQ Modifier: Use this for “asynchronous” telemedicine. This applies when there’s no real-time interaction, like when a patient sends images or videos for you to review later.
When to Use Place of Service Codes 02 and 10
While modifiers explain how a service was delivered, the Place of Service (POS) code explains where the patient was located during the visit. This distinction is critical for payers to process your claim correctly.
There are two main POS codes for telehealth:
- POS 02: Use this code when the patient is receiving telehealth services at a location other than their home. This could be another clinic, a hospital, or a skilled nursing facility. It signals that the patient is at an approved originating site.
- POS 10: This code is specifically for telehealth services provided while the patient is in their home. As at-home virtual care has become more common, you’ll find yourself using this code frequently. You can find more detailed guidance on how to code for telehealth from industry resources.
How to Select the Correct Modifier
So, how do you choose the right modifier? The simple answer is: it depends on the payer. While these codes have standard definitions, each insurance company has its own specific rules and preferences. For example, Medicare might require one modifier for a specific service, while a commercial insurer might require another for the exact same service.
The best practice is to always verify the requirements for each payer before submitting a claim. Payer guidelines can change, so staying updated is non-negotiable for accurate medical billing. Keeping a running list of each payer’s telehealth policies or working with a billing partner can save you countless hours and prevent costly claim denials.
How Different Payers Handle Telehealth Reimbursement
One of the biggest hurdles in telehealth billing is that there isn’t a universal set of rules. How you get paid for virtual services depends entirely on the payer—and their policies can feel like a moving target. Medicare, commercial insurance companies, and state Medicaid programs each have their own distinct guidelines for what they cover, which codes to use, and how much they’ll reimburse. This patchwork of policies means your billing team has to be diligent about verifying requirements for each patient before their virtual visit.
Understanding these differences is key to maintaining a healthy revenue cycle and avoiding claim denials. A claim that’s perfectly coded for a Medicare patient might be instantly rejected by a commercial insurer. That’s why it’s so important to stay informed and create a process for checking each payer’s specific rules. Let’s break down what you can generally expect from the three main types of payers so you can prepare your practice for success.
Medicare’s Rules and Limitations
When it comes to telehealth, Medicare has some very specific and evolving rules. It’s crucial to remember that Medicare has stated it will not accept the new 98000-series telemedicine codes, with the single exception of 98016, the brief virtual check-in code. Instead, you’ll need to continue using standard E/M codes with either modifier 95 (for audio-video) or 93 (for audio-only). Providers should always check the latest list of covered telehealth services to ensure compliance.
Congress has extended the major Medicare telehealth flexibilities through December 31, 2027. Until then, Medicare patients can receive covered telehealth services — including audio-only visits billed with modifier 93 — from any location, including their homes, without the old rural and originating-site restrictions. The in-person visit requirement for behavioral health telehealth has also been deferred and is now scheduled to take effect January 1, 2028.
What to Expect from Commercial Insurers
Commercial insurance plans are a mixed bag. While some have started to adopt the new 2025 telehealth codes, many others have not yet updated their policies. This inconsistency means you can’t make any assumptions. The most important step your practice can take is to contact each insurance company directly to confirm their preferred coding method. Do they want the new telehealth codes, or do they require E/M codes with a modifier?
Getting this confirmation upfront can save you from countless denials and follow-ups. As you submit claims, keep a close eye on your reimbursement rates to make sure you’re being paid correctly, no matter which coding method the payer requires. Managing these variations is where expert medical billing services can make a significant difference.
State-by-State Differences in Medicaid
Medicaid telehealth policies are determined at the state level, which means the rules can vary dramatically depending on where your practice and patients are located. Each state has its own guidelines for what services are covered, which provider types are eligible for reimbursement, and what constitutes an appropriate patient setting. Because of this, it’s essential to check the specific rules for your state’s Medicaid program.
For patients who are dually eligible for Medicare and Medicaid, the billing process can become even more complex. As with commercial payers, the best practice is to always verify coverage and billing requirements directly with your state’s Medicaid agency before providing services. This proactive approach helps ensure you’re following the correct procedures and will be reimbursed properly for the care you provide.
Common Telehealth Billing Challenges to Avoid
Telehealth offers incredible convenience for you and your patients, but the billing side can present some unique hurdles. Getting ahead of these common issues is the key to preventing claim denials and keeping your revenue cycle healthy. Think of it as a simple checklist to run through so you can focus more on patient care and less on administrative headaches. By understanding where things can go wrong, you can build a process that ensures you get paid correctly and on time for the virtual services you provide.
Keeping Up with Changing Codes and Policies
One of the biggest challenges in telehealth billing is that the rules are a moving target. Policies from Medicare, state Medicaid programs, and private insurance companies can change frequently, and it’s your responsibility to stay current. For example, many of the relaxed telehealth rules from the public health emergency are being phased out, and some of Medicare’s pre-pandemic restrictions are returning. This means you need to pay close attention to things like approved patient locations, which often must be in a designated rural or health professional shortage area. Staying informed requires a proactive approach to billing for telehealth and regularly checking for updates from your major payers.
Verifying Insurance Coverage for Virtual Visits
Never assume a patient’s plan covers telehealth services, even if it seems standard. Just like with an in-person visit, you must verify eligibility and benefits before the appointment. Each payer has its own set of rules for what’s covered, how it should be coded, and what the reimbursement rates are. It’s essential to contact every insurance company you work with to get clarity. Ask them directly if they want you to use the latest telehealth CPT codes or if they prefer traditional E/M codes with a specific modifier. This simple verification step can save you from countless denials and follow-up calls down the road.
Ensuring Proper Documentation and Compliance
Your clinical notes are your best defense against a claim denial. For telehealth, documentation needs to be just as thorough as it is for an in-person encounter, with a few extra details. You must clearly document the modality used (e.g., synchronous audio-video) and justify the medical necessity of the service. If a patient uses an audio-only service, for instance, your notes must explain why—for example, you should show that video was available, but the patient either preferred or was unable to use it. Always check the specific documentation and billing guidelines for each payer to ensure you’re compliant and can secure proper reimbursement.
Tips for Accurate Telehealth Billing
Getting telehealth billing right is about more than just avoiding denials—it’s about securing the revenue you’ve earned and maintaining a healthy cash flow for your practice. With policies and codes in constant flux, a proactive approach is your best strategy. Small, consistent efforts to refine your process can make a huge difference in your reimbursement rates and reduce administrative headaches. Here are a few key areas to focus on to ensure your telehealth claims are clean, compliant, and paid on time.
Stay Current on Code Updates
Telehealth billing isn’t a “set it and forget it” task. The rules are complex and change frequently, so you have to stay on top of the latest policies from Medicare, Medicaid, and commercial payers. For example, the 98000-series telemedicine codes now distinguish different types of telehealth services, replacing the temporary reporting methods used during the public health emergency. To keep up, it’s wise to follow updates from CMS and professional organizations. You can also find helpful resources and best practice guides to bill for telehealth from government health agencies.
Perfect Your Verification and Documentation Process
Before every virtual visit, your front office should verify the patient’s insurance coverage for telehealth services. Each payer has unique rules, and confirming eligibility upfront is the first step in preventing a denial. Your documentation also needs to be impeccable. If a patient uses an audio-only service when video was an option, your notes must clearly state why. This detail can be the difference between a paid claim and a rejection. Consistently checking the billing guidelines for each specific insurance company is essential. If this process becomes overwhelming, partnering with a dedicated medical billing service can ensure every claim is properly verified and documented.
Optimize Your Billing to Improve Revenue
Accurate billing directly impacts your practice’s bottom line. It’s a good habit to regularly review your telehealth reimbursements to ensure you’re being paid correctly. Pay close attention to how much you receive for virtual services, especially as new coding structures are introduced. The 98000-series codes, for instance, allow payers to reimburse telehealth visits differently than in-person appointments. Keeping a close eye on these payments helps you spot underpayments quickly and address them with the payer. This kind of financial oversight is a core part of effective practice management consulting and is crucial for long-term financial health.
Related Articles
- Telehealth Reimbursement 2025: A Complete Guide
- Will Medicare Cover Telehealth in 2025? A Guide
- Behavioral Healthcare Billing 101: The Ultimate Guide
Frequently Asked Questions
What’s the biggest change coming to telehealth billing in 2025? The most significant shift is the introduction of a new, permanent set of CPT codes (the 98000 series) specifically for telehealth. These codes replaced the temporary rules we’ve been using for the past few years. They create a clear distinction between services delivered with both audio and video versus those that are audio-only, which brings more consistency to how you report virtual care.
Do I use these new 98000-series codes for all my patients, including Medicare? No, and this is a critical point to remember. Medicare has stated it will not adopt the new 98000-series codes. For your Medicare patients, you will continue to use the standard office visit E/M codes (like 99214) and attach the appropriate telehealth modifier, such as 95 for video visits or 93 for audio-only calls. Always check with commercial payers, as their adoption of the new codes will vary.
Why is the payment for a telehealth visit often less than for an office visit? Reimbursement for telehealth is typically lower because the practice expense component of the payment is reduced. This portion of the fee covers overhead costs like rent, supplies, and clinical staff, which are lower for a virtual appointment. Payers calculate a lower total reimbursement because your practice’s direct costs for conducting the visit are less than they would be for an in-person encounter.
What’s the most common documentation mistake practices make with telehealth? A frequent oversight is failing to properly justify an audio-only visit. Your clinical notes must explain why a video connection wasn’t used. For example, you should document that video technology was available, but the patient either could not use it or declined to use it. Without this specific detail, your claim for an audio-only service is at high risk for denial.
With so many different payer rules, what’s the best way to avoid denials? The most effective strategy is to verify telehealth benefits and billing rules for each patient before their appointment. You can’t assume that one payer’s policy is the same as another’s. Create a process to contact each insurance company to confirm which codes and modifiers they require. Keeping a simple cheat sheet of each payer’s preferences can save your team a lot of time and prevent rejected claims.
