Billing for telehealth: A guide to the new frontier of medical services

Telehealth has become a regular part of healthcare delivery, especially after the COVID-19 pandemic pushed providers and patients to adopt virtual care quickly. While technology has made care more accessible, figuring out how to bill for telehealth can feel overwhelming. Rules are changing, codes keep evolving and each payer seems to have its own policies.

This makes billing far more than a paperwork task. By getting medical billing right, providers can get paid fairly and stay compliant, all while helping patients access the virtual care they deserve.

But how do we get billing right when virtual care is changing so fast? This article will walk through the essentials of telehealth billing, from coding and modifiers to Medicare policies and the opportunities ahead.

The benefits of telehealth

Before discussing the billing complexities of telehealth, it’s worth remembering why providers are doing this work in the first place. Telehealth has changed healthcare delivery in ways that create genuine value.

For patients, the benefits are obvious: no more taking time off work for a routine followup, no sitting in crowded waiting rooms when you’re under the weather and no scrambling to find childcare for a quick check-in appointment. Telehealth has also made healthcare more accessible for people in rural areas who previously had to drive long distances to see specialists, and it’s been especially valuable for patients with mobility issues or chronic conditions that make frequent in-person visits challenging.

The clinical draw is equally compelling. Mental health services have seen remarkable success through telehealth platforms, with many patients reporting they feel more comfortable discussing sensitive topics from the privacy of their own homes. Chronic disease management has improved as providers can check in more frequently with patients who might otherwise skip appointments due to inconvenience. And for certain specialties like dermatology or psychiatry, virtual visits often provide the same quality of care as in-person encounters.

From a provider perspective, telehealth can improve practice efficiency when implemented thoughtfully. It reduces no-show rates significantly, since patients are much more likely to attend a virtual appointment they can join from anywhere. Telehealth also allows providers to see patients during weather emergencies or other situations that might otherwise cancel a full day of appointments. Some practices have found that telehealth slots help them manage patient demand more effectively, offering quick virtual check-ins for straightforward concerns while reserving in-person slots for patients who truly need hands-on care.

“Studies have consistently shown that the quality of healthcare services delivered via telehealth is as good as those given in traditional in-person consultations,” the American Telemedicine Association (ATA) said.

But here’s the thing that makes proper billing so crucial: none of these benefits matter if providers can’t get paid fairly for virtual care. Yet when telehealth billing is done right, it supports sustainable virtual care programs that can continue serving patients long-term.

“The greatest impact of telehealth is on the consumer, their family and their community,” the ATA said.

How to code for telehealth visits

Coding plays a core role in billing, and for telehealth, it can be confusing to know which codes apply. Billers can bill most visits with the same evaluation and management (E/M) codes you would use for in-office visits, such as 99202-99215. The American Medical Association (AMA) has also introduced telehealth-specific CPT codes, but not every payer recognizes them.

Here are some of the most important points to keep in mind when coding for telehealth visits, according to the AMA:

• Use standard E/M codes like 99202-99215 for most telehealth encounters.
• Medicare does not recognize new AMA telehealth codes 98008-98015, so using them will result in claim denials.
• For short virtual check-ins, Medicare replaced G2012 with CPT 98016, which covers up to 10-minute communications unrelated to a recent or upcoming E/M service.
• Prolonged telehealth services can be billed with add-on code 99417 once a visit extends by at least 15 minutes.

In short, coding for telehealth often looks similar to in-person visits, but small differences can have a real impact. Knowing which codes Medicare accepts, and when to use them, can help avoid frustrating denials and delayed payments.

Where modifiers and place of service codes come in

Once you select the right code, you also need to make sure modifiers and place of service (POS) codes are correct. These details tell payers how the visit happened and where the patient was during the service.

Here are the key ones to remember:

The right combination of code, modifier and POS tells the full story of the encounter. For example, billing a 99213 with modifier 93 and POS 10 clearly shows an audio-only telehealth visit with a patient in their home. By getting these details right, payers can make certain they process claims correctly.

Medicare and payer-specific policies

Medicare has been the leader in helping to determine telehealth policy, especially with temporary flexibilities that started during the pandemic. Many of these flexibilities are still in place, although some are scheduled to expire in late 2025 unless Congress extends them.

Here are the most critical current Medicare rules:

• Telehealth services are covered for patients in any location, not just rural or medical facilities, through September 30, 2025.
• Both audio-video and audio-only visits are covered, as long as the correct modifier is used.
• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as distant site providers, with payments calculated at national averages through December 2025.
• For behavioral health telehealth, in-person visit requirements have been delayed until at least April 2025 for most providers and January 2026 for FQHCs and RHCs.
• Audio-only telehealth is permanently covered for behavioral and mental health services.

Commercial insurers and Medicaid programs set their own rules. Medicare Advantage plans often offer broader coverage, while Medicaid varies from state to state. Providers need to check each payer’s telehealth policies to avoid assumptions that all rules are the same.

In summary, Medicare sets the tone for telehealth billing, but private insurers and Medicaid can differ significantly. Staying updated on payer policies is the only way to avoid costly mistakes.

Challenges in telehealth billing

Billing for telehealth brings its own set of obstacles. Providers often struggle to keep up with frequent policy updates while trying to maintain a high standard of care.

Some of the most common challenges include:

• Policies that change quickly and require constant monitoring.
• Confusion about which codes Medicare recognizes versus what private insurers may allow.
• Errors with modifiers, such as forgetting to add 95 or 93 when needed.
• Mistakes with POS codes, which can cause payers to reject claims.
• Documentation gaps, especially for audio-only visits, where you must explain why the patient and provider did not use video.

These challenges can feel daunting, but they are manageable with the right processes in place. By investing time in training, documentation and regular policy reviews, providers can avoid many of the pitfalls.

Opportunities in telehealth billing

While challenges exist, there are also opportunities to improve how telehealth billing works. Providers who adapt early can avoid delays and even streamline their revenue cycle.

Here are some strategies that can make a difference:

• Stay informed by subscribing to updates from the Centers for Medicare & Medicaid Services (CMS), the Department of Health & Human Services (HHS) and professional associations.
• Update billing software and EHR systems so they flag unaccepted codes and automatically apply correct modifiers and POS codes.
• Provide regular staff training to keep teams confident about new codes and documentation requirements.
• Use short-visit codes, such as CPT 98016, strategically for quick virtual check-ins.
• Develop payer-specific billing protocols so staff know what to do for Medicare, Medicaid and private insurers.

The main opportunity is to treat telehealth billing like a moving target. Practices that adjust quickly can reduce denials and speed up payments. This will help them maintain a steady revenue stream even as rules evolve.

Closing thoughts

Telehealth is here to stay, and billing for virtual care has become a standard part of healthcare administration. The rules may change, but the fundamentals remain the same: choose the right code, apply the correct modifier, use the proper place of service code and document thoroughly.

Providers who take the time to understand these details and train their staff, and those who keep up with policy updates, will be better prepared for the future. Telehealth billing may be complex, but with the right knowledge and systems in place, it is entirely manageable.