Telehealth is now a routine part of care, but billing for it is still one of the most confusing areas for practices. The rules differ by payer, and they have changed several times in recent years. This quick reference covers the codes and rules you'll use most often.
Place of service codes
The place of service (POS) code tells the payer where the patient was during the visit:
- POS 02: telehealth provided other than in the patient's home, such as when the patient is at a clinic or other facility.
- POS 10: telehealth provided in the patient's home, or another private location where the patient receives care.
Some payers, including some Medicare programs in certain situations, instead ask you to report the POS that would have applied if the visit had been in person, along with a telehealth modifier. Always check the payer's current policy.
Telehealth modifiers
- Modifier 95: a synchronous telemedicine service delivered by real-time audio and video.
- Modifier 93: a synchronous telemedicine service delivered by audio only.
- Modifier FQ: used by Medicare for certain audio-only services.
- Modifier GT: an older telehealth modifier that some payers still require for specific programs.
Common telehealth codes
- Office and outpatient E/M (99202 to 99215). Many payers, including Medicare, still want these standard codes for telehealth visits, reported with the right POS and modifier.
- Telemedicine E/M codes (98000 to 98015). CPT added this family of codes for audio-video and audio-only visits. Coverage varies widely, and many payers, including Medicare, have not adopted most of them, so confirm before you use them.
- Virtual check-ins and e-visits. Brief communication codes (such as 98016) and online digital E/M services (99421 to 99423) cover short, patient-initiated contacts that are not full visits.
- Behavioral health (90791, 90832 to 90838 and others). Psychotherapy and diagnostic evaluations are among the most commonly billed telehealth services.
Rules that cause the most denials
- Payer-specific policies. Commercial and Medicaid plans each publish their own telehealth policies, including which codes, modifiers and POS they accept.
- Audio-only coverage. Not every service can be billed when video isn't used. Document why audio only was used when the payer requires it.
- Provider and patient location. Payers may require the patient's location in the note, and state licensing rules apply to the state where the patient is located.
- Consent and documentation. Record the patient's consent, the technology used, both locations and the time spent when time determines the code.
- Medicare flexibilities. Many Medicare telehealth flexibilities have been extended several times by Congress. Check the current status before each new year so your billing matches the rules in effect on the date of service.
A simple checklist for every telehealth claim
- Confirm the payer covers the service by telehealth.
- Use the correct CPT or HCPCS code for the service and modality.
- Choose the POS the payer requires.
- Add the right modifier (95, 93, FQ or GT) for that payer.
- Make sure the documentation shows consent, locations, modality and medical necessity.
Telehealth billing gets much easier with a payer-by-payer reference that is kept up to date. Our team maintains those rules for our clients every day. Learn more about our telehealth billing services.
