telehealth codes in medical billing
The Complete Guide to Telehealth Codes in Medical Billing 2025
INTRODUCTION
Telehealth started as a temporary solution during the Covid-19 pandemic and became a vital part of healthcare service delivery in the United States. But with that evolution comes a critical need for accuracy in medical billing practices for telehealth, especially in understanding and using telehealth codes in medical billing.
In this blog, we will explore what medical providers, telehealth billing specialists, and healthcare clinics need to know in 2025: from CPT and HCPCS codes to POS indicators, modifiers, payer policies, and best practices for documentation. Whether you are billing for a simple patient visit over a phone call or managing a remote patient monitoring (RPM) program, the accurate knowledge ensures timely reimbursement and reduces the likelihood of claim denials.
For doctor’s office, getting paid accurately for online patient visits, what we call “Telehealth billing,” is really important. Think of “Telehealth CPT code” as the secret to getting paid for the time and care you render online. CPT codes are just short ways to explain what kind of healthcare was provided. This read is all about making those telehealth codes easy to grasp so your bills go through without a hitch. Using the right codes also means you should get paid equally for assisting patients online as you would if they came to your office – that’s what “telehealth payment parity” means.
BLOG OUTLINE
- What Is Telehealth
- Importance of Telehealth Codes in Medical Billing
- Common CPT Telehealth Codes in Medical Billing
- Modifiers Used with Telehealth Codes in Medical Billing
- POS Codes for Telehealth
- Telehealth Documentation Requirements
- Medicare, Medicaid, and Commercial Payer Rules in 2025
- Common Mistakes with Telehealth Codes in Medical Billing
- Best Practices for Successful Telehealth Billing
- Final Thoughts: Why Telehealth Billing Accuracy Matters
- Frequently Asked Questions
What Is Telehealth?
Telehealth refers to the use of electronic information and telecommunication forums to deliver clinical healthcare services from a distance. It enhances access to care, especially for patients in rural or underserved areas, and supports the ongoing management of chronic conditions. The four main categories of telehealth services include:
- Synchronous Telehealth: Real-time, interactive audio-video communication between a patient and provider.
- Asynchronous (Store-and-Forward): Transmission of medical data (e.g., images, labs) for evaluation at a later time.
- Remote Patient Monitoring (RPM): Collection and transmission of health data like blood pressure, glucose, or oxygen levels.
- Mobile Health (mHealth): Use of mobile apps and devices for patient health tracking and education.
Each category has different billing requirements, codes, and modifiers.
Importance of telehealth codes in medical billing
Now, sending a bill for an online visit is not the same as when patients comes to your clinic. One big thing is to present clear notes about what happened during the online patient visit. These notes help you pick the right telehealth code, that special number for online assistance, also called the telehealth codes in medical billing. In addition, the code you use changes if the visit was live, like a video call, or if it was not live, like sending video or messages back and forth later.
When you are trying to find the right telehealth code, a few things will help. It depends on what kind of help you gave – was it a check-up, talking about feelings, or checking on someone with machines at home? It also matters how you did the online visit – video, just talking, or using those home machines? And sometimes, you get paid based on how long you talked to the person (telehealth billing by time) instead of just what kind of visit it was. Lastly, the rules from different health plans, like medicare telehealth billing guidelines 2025, anthem telehealth billing guidelines 2023, bcbs telehealth billing guidelines 2024, and others, will tell you which code to use.
Using precise telehealth codes in medical billing affects:
- Reimbursement Rates: Under-coding risks lost revenue; over-coding invites audits.
- Compliance: Adhering to Medicare, Medicaid, and commercial payer rules prevents denials and penalties.
- Claim Quality: Fully documented, code-accurate claims pass through clearinghouses faster.
- Patient Satisfaction: Clear billing reduces patient billing inquiries and surprises.
Without up-to-date code knowledge, practices face delays from denials for missing modifier 95, wrong POS codes, or unsupported services.
Common CPT Telehealth codes in medical billing
When you use these telehealth billing cpt codes, make sure your notes say clearly what happened. Also, billing for someone you are seeing online for the first time might be a bit different than billing for someone you have seen online before. If you help people with their feelings online, there are often special codes for that. You should know if there are any special rules for these telehealth billing codes. Then there are also codes for when you watch over patients from far away, using machines they have at their house. These telehealth billing cpt codes have their own rules about when you can use them. You might also find codes for other kinds of online doctor help, like looking at x-rays from far away or giving advice to another doctor online. Current Procedural Terminology (CPT) codes are used to report medical, surgical, and diagnostic procedures and services.
1
Evaluation and Management (E/M) Visit Codes
99202–99205: New patient visits (based on time or medical decision-making).
99212–99215: Established patient visits.
These codes are used when real-time audio-video communication is involved.
Must meet all documentation and time-based criteria.
2
Digital Evaluation Codes (Asynchronous Communication)
99421–99423: Online digital E/M services via secure portal.
Based on cumulative time spent over a 7-day period.
Often used in patient follow-ups and non-urgent care.
3
Audio-Only Telehealth Codes
99441–99443: Telephone E/M services by a physician or qualified health professional.
Duration-based: 5–10, 11–20, or 21–30 minutes.
Note: Not all payers reimburse for these, though Medicare extended their coverage through 2025.
HCPCS codes in Telehealth billing
The Healthcare Common Procedure Coding System (HCPCS) complements CPT codes and is used especially for Medicare and Medicaid billing.
Common HCPCS Codes
- G2010: Remote evaluation of recorded video/images submitted by patient.
- G2012: Brief communication technology-based service (virtual check-in).
- G2250/G2251: Store-and-forward services.
- G2252: Extended virtual check-in (11–20 minutes)
These HCPCS codes for telehealth are important when billing for services that don’t fall under traditional CPT-based encounters.
Remote Patient Monitoring (RPM) telehealth Billing Codes
Remote Patient Monitoring (RPM) has become one of the fastest-growing telehealth segments, especially for chronic care management.
Key CPT Codes for RPM
- 99453: Setup and patient education on the use of RPM equipment.
- 99454: Daily recordings or programmed alerts transmission.
- 99457: First 20 minutes of RPM treatment management per calendar month.
- 99458: Each additional 20 minutes.
These codes are time and data-dependent. For example, 99454 require data transmission for at least 16 days out of a 30-day period.
Modifiers used with Telehealth codes in medical Billing
Modifiers help clarify how a service was rendered. Proper modifier usage can make or break your reimbursement.
COMMON MODIFIERS IN TELEHEALTH BILLING
Modifier 95
Indicates a real-time, synchronous telehealth service (audio and video).
Modifier GT
Some payers (non-Medicare) still require GT for interactive telehealth.
Modifier GQ
Asynchronous (store-and-forward) telehealth services.
Modifier CR
Catastrophe/disaster-related services.
Modifier 95
Widely accepted across Medicare, Medicaid, and commercial payers, especially when billing CPT codes for telehealth.
POS codes for telehealth billing
Place of Service (POS) codes indicate where the service was provided. They are essential for payer processing and determining reimbursement rates.
Using the correct POS code with the appropriate modifier is crucial to avoid rejections. For example, a virtual home visit using video should be reported with POS 10 and Modifier 95.
Telehealth billing Documentation Requirements
Proper documentation supports the medical necessity of the telehealth service and ensures compliance during audits.
- Patient consent to receive telehealth services.
- Type of telehealth service (e.g., audio-video, audio-only).
- Platform or technology used.
- Start and end time of the visit.
- Location of both patient and provider.
- Detailed clinical note (history, exam, decision-making).
Failing to document any of these components could result in denied or recouped claims.
Medicare, Medicaid, and Commercial Payer Rules for telehealth
What Medicare, the government health plan, says is really important. Their rules for telehealth codes might have changed over time – for example, the rules from telehealth billing medicare 2022 might not be the same as the medicare telehealth billing guidelines 2025 rules. You’ll also need to know which extra marks to use and how to say where the service happened when you bill Medicare. Sometimes, Medicare might even help pay for an online doctor’s note without the person paying extra, and there might be special codes for that telehealth medical certificate bulk bill situation.
Then you have all the other health plans, like anthem telehealth billing guidelines 2023, BCBS telehealth billing guidelines 2024, Regence telehealth billing guidelines 2024, Cigna telehealth billing guidelines, Bcbsil telehealth billing guidelines 2024, Fidelis telehealth billing guidelines, Healthfirst telehealth billing guidelines, and Humana telehealth billing guidelines. Each of these plans has its own way of paying for telehealth. You need to check with each one to see what codes they like and what extra marks you need to use. Even though their rules can be different, you might see some things that are the same across many plans. Also, the rules in your state can change which telehealth cpt codes you can use and how you get paid, so that’s something else to think about.
- Covers audio-only codes (99441–99443) through December 2025.
- Requires POS 10for home-based telehealth.
- Still demands full documentation, time tracking, and medical necessity.
- RPM coverage remains, with 16-day data requirement for CPT 99454.
- State-specific policies apply.
- Some states offer enhanced RPM coverage or cover mHealth services.
- Modifier and POS code requirements vary significantly.
Variable policies: Some align with Medicare; others have their own rules.
May require prior authorization or payer-specific modifiers.
Encourage checking each plan’s telehealth billing policies quarterly.
Common Mistakes with Telehealth Codes in Medical Billing
Even experienced billing teams can make costly mistakes. Here are some of the most common:
- Using the wrong modifier (e.g., GT instead of 95).
- Failing to include POS 10 for home-based telehealth.
- Billing audio-only CPT codes for services requiring video.
- Submitting RPM codes without required days of data transmission.
- Incomplete documentation, especially around consent and visit duration.
Internal audits and regular team training can drastically reduce these errors.
| MISTAKES | IMPACT | PREVENTION |
|---|---|---|
| Omitting Modifier 95 | Claim Denial | Implement software checks & staff training |
| Using POS 11 (in-office) instead of 02/10 | Incorrect Reimbursement | Standardized billing templates for telehealth visits |
| Billing e/m codes for audio-only visits | Non-covered Service Denial | Verify payer acceptance of 99441-99443 before submission |
| RPM codes without ≥ 16 days of data | Audit Flags & Denials | Track device data adherence & certify days in documentation |
| Failing to document patient consent | Compliance Risk | Include auto-populated consent statements in EHR templates |
Best Practices for Telehealth Medical Billing
To improve reimbursement and compliance:
- Stay updated on payer policies monthly or quarterly.
- Use payer-specific billing guides for telehealth.
- Audit claims regularly for accuracy.
- Maintain comprehensive documentation.
- Educate staff and providers on telehealth billing workflows.
- Leverage technology and EHR templates to reduce errors.
Being proactive can prevent delays and denials—and helps ensure financial sustainability.
Why Telehealth Codes in Medical Billing Matters
In 2025, telehealth codes in medical billing are more nuanced and vital than ever. With multiple coding systems (CPT, HCPCS), documentation demands, and payer-specific rules, it’s critical to stay informed. From using the right POS code to documenting patient consent and timing, accuracy can make the difference between timely payment and denied claims.
Mastering the correct application of CPT codes for telehealth, remote patient monitoring billing, and audio-only visit codes will ensure your practice remains compliant, efficient, and profitable in this fast-changing virtual care landscape.
faqs: telehealth codes in medical billing
Can audio-only telehealth still be billed in 2025?
Yes. Medicare continues to cover audio-only codes like 99441–99443 through 2025, but commercial insurers may differ.
What's the difference between POS 02 and POS 10?
Even the all-powerful Pointing haA: POS 02 indicates a virtual service delivered outside the home (like a clinic), while POS 10 is used when the patient is at home.
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Is Modifier 95 mandatory in telehealth billing?
Yes, for most real-time audio-video telehealth visits billed under CPT codes. It’s widely recognized by Medicare and private payers.
How many days of data are needed for RPM billing with CPT 99454?
At least 16 days of transmitted data in a 30-day period are required.
Can I bill telehealth for a nurse practitioner visit?
Yes. Telehealth billing applies to a wide range of licensed providers, including NPs, PAs, and behavioral health specialists.
What is the best company for telehealth billing?
MedStates, with a proven track record of more than a decade is the best medical billing company for telehealth services
