Telehealth Billing Guide 2025: CPT Codes, Modifiers, and Reimbursement Rules for U.S. Providers
GET EXPERT TIPS ON PAYMENT RULES, COMMON CODING MISTAKES, AND BUILDING AN EFFICIENT PRACTICE WITH MEDSTATES TELEHEALTH BILLING SERVICES
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- How Billing for Online Visits Works: CPT & HCPCS Codes Explained
- Telehealth Reimbursement Rules: Medicare Vs. Commercial Payers
- Why Choosing a Good Medical Billing Company for Telehealth is So Important
- Understanding Telehealth Modifiers: 95, GT, And GQ Codes
- Important Things to Remember for Online Billing
- Top Telehealth Billing Mistakes and How to Prevent Them
- Making Telehealth Billing Easier for Your Office
- Conclusion: Simplifying Telehealth Billing for Your Practice
As telehealth continues to redefine modern care delivery, understanding how to bill for virtual services is critical for providers. This telehealth billing guide helps physicians, clinics, and billing professionals navigate telemedicine reimbursement, CPT and HCPCS coding, modifier usage, and Medicare telehealth policies. Whether you’re billing for video visits, remote patient monitoring, or audio-only services, this guide offers step-by-step insights to ensure accurate claims and maximize reimbursement. Learn how to stay compliant, avoid costly errors, and optimize billing for both commercial and public payers.
How Telehealth Billing Works: CPT & HCPCS Codes Explained
When you see a patient online, the way you bill for it isn’t exactly the same as when they come to your office. One important thing is to write good notes about the visit. These notes help you choose the right code, which is like a special number for online visits (telehealth code for billing). Also, sometimes the rules for billing can change depending on where the patient is and where you are when you have the online visit.
Getting paid for online visits follows a few steps.
- First, you need to make sure the patient understands and agrees to have an online visit.
- Then, you need to choose the correct telehealth billing codes.
- Sometimes, how you bill depends on how long the visit lasts (telehealth billing by time) rather than just the type of visit
- After the visit, you send the bill with these special codes to the insurance company.
- When your office receives payment, you need to check if the amount is right.
- If it's not, you might need to contact the insurance company again to get it corrected.
When billing for telehealth services, it’s crucial to use the appropriate CPT and HCPCS codes. These vary depending on whether you’re billing for video visits, RPM (remote patient monitoring), or audio-only consultations.
Telehealth Reimbursement Rules: Medicare vs. Commercial Payers
Different groups have different rules about paying for online doctor visits. Medicare’s telehealth reimbursement rules for 2025 continue to evolve, with updates to originating site requirements, POS code usage, and expanded coverage for chronic care management via telemedicine.. For example, the medicare telehealth billing guidelines 2025 could be different from what they were in the past (telehealth billing medicare 2022). Sometimes, Medicare might help pay for an online doctor’s note without the patient paying extra, which is called a telehealth medical certificate bulk bill. It’s important to know the specific rules Medicare has for online visits.
Different insurance companies — like Anthem , BCBS, Regence , Cigna, BCBSIL , Fidelis, Healthfirst, and Humana — each have their own telehealth billing policies.
It’s important to check with each insurer to understand what services they cover and what billing steps you must follow to get paid.
Although their rules may vary, many companies share some common requirements for telehealth billing.
| ASPECT | MEDICARE | COMMERCIAL PAYERS |
|---|---|---|
| Covered Services | Limited list, often updated annually | Varies by payer and plan |
| Accepted Modifiers | 95, GT, GQ | 95, GT, GQ (may vary) |
| POS Codes | 02 or 10 | POS 02, 10, or in-person POS (per payer rules) |
| Audio-Only Coverage | Some services (e.g., behavioral health) | Some plans support audio-only |
| Payment Parity | Often reduced vs. in-person | Some states enforce parity; varies widely |
Why Choosing THE BEST Company for Telehealth BILLING is Important
Dealing with telehealth billing can be complicated, with all the different rules from Medicare (medicare telehealth billing guidelines 2025) and other insurance companies (anthem telehealth billing guidelines 2023, bcbs telehealth billing guidelines 2024, etc.). A good medical billing company like Medstates that really knows medical billing for telehealth services can be a huge help. They stay up-to-date on all the latest rules and coding (telehealth billing codes, telehealth billing cpt, telehealth code for billing) and can make sure your claims are submitted correctly. This means you are more likely to get paid the right amount and avoid delays or denials. Trying to keep up with all these rules yourself can take a lot of time and effort. Hiring experts in telehealth billing lets you focus on taking care of your patients, knowing that your billing is in good hands. They can also help you understand things like telehealth billing by time and make sure you are following all the guidelines, including those that might affect things like a telehealth bulk bill medical certificate.
Understanding Telehealth Modifiers: 95, GT, and GQ Codes
Just like for in-person visits, there are special codes used when billing for telehealth. These telehealth billing cpt codes tell the insurance company exactly what kind of online service you provided. There’s also a specific telehealth code for billing that helps show that the visit happened online.
Sometimes, you need to add a small extra code, called a modifier, to the main billing code. These modifiers, like GT or modifier 95 for real-time interactive video visits, and GT for synchronous telemedicine conducted via telecommunications systems. These telehealth modifiers ensure accurate payer processing. Knowing when to use each of these modifiers is important for getting paid correctly according to the insurance rules. Also, how you bill might be a little different depending on whether you had a live video call, exchanged messages, or used devices to check on a patient remotely.
Modifier 95: Real-time, synchronous telehealth via audio-video.
Modifier GT: Telehealth through interactive audio and video telecommunications system.
Modifier GQ: Asynchronous telecommunication systems (store and forward).
Modifier CR: Catastrophe/disaster-related telehealth services.
Important Things to Remember for VIRTUAL VISITS Billing
To make sure you get paid for your online visits, there are a few key things to keep in mind.
- First, always get the patient’s okay to have a telehealth visit and make sure to note this in their records. When you write your notes about the visit, include enough detail, and if you’re billing based on time (telehealth billing by time), make sure to record how long the visit lasted.
- It’s also crucial to check with the patient’s insurance to see if they cover telehealth visits before the appointment.
- Remember that the rules for online health visits can also vary from state to state.
- Finally, the world of telehealth billing is always changing, so it’s important to stay up-to-date with the newest guidelines. For example, keep an eye out for updates like telehealth billing 2024.
Top Telehealth Billing Mistakes and How to Prevent Them
There are some common mistakes that can cause problems with telehealth billing including failure to document HIPAA-compliant telehealth encounters or submitting claims without the right POS code can lead to denials and revenue loss.
Missing or incorrect telehealth modifier
Using outdated CPT codes
Submitting claims without audio/video documentation
Confusing POS 02 vs. POS 10 usage
Billing non-covered services for Medicare
Making Telehealth Billing Easier for Your Office
Following ways assist you to bill for online visits smoother.
Verify payer-specific telehealth eligibility.
- Make sure your staff is well-trained on selecting the correct CPT/HCPCS telehealth billing codes, applying appropriate telehealth modifier (95, GT, etc.) and documenting telehealth visits.
Use the correct POS code (e.g., POS 02 for telehealth).
Using billing software that is regularly updated with the newest telehealth rules and insurance guidelines
Submit clean claims and track payment timelines.
Conclusion: Simplifying Telehealth Billing for Your Practice
As telehealth continues to transform the U.S. healthcare landscape, accurate and compliant billing is more crucial than ever. From using the correct CPT codes and modifiers to understanding POS codes and payer-specific rules, success depends on staying updated and proactive. Whether you are a small private practice or a multi-specialty clinic, navigating telehealth billing in 2025 requires expertise, precision, and constant adaptation. With Medicare and commercial insurers updating reimbursement rules regularly, having the right billing partner makes all the difference. MedStates is the trusted medical billing company for telehealth providers across the U.S. We specialize in:
Correct CPT and HCPCS coding for virtual care
Modifier 95, GT, GQ usage and POS compliance
Maximizing Medicare and private insurance reimbursements
Reducing denials and improving claim accuracy
Contact us today to streamline your telehealth billing, stay compliant, and boost revenue with confidence.
