Telehealth has become an essential component of modern healthcare delivery, but billing for these services remains complex and ever-changing. With varying payer requirements and evolving regulations, providers need a clear strategy to ensure proper reimbursement for telehealth services. This guide covers the essential best practices for telehealth billing in 2025.

Understanding Telehealth Billing Fundamentals

Telehealth billing differs from traditional in-person visits in several key ways:

• Place of Service (POS) codes: Typically POS 02 for telehealth
• Modifiers: Required by many payers to identify telehealth services
• Originating site requirements: Some payers restrict where patients can receive telehealth
• Technology requirements: Specific platforms may be required for reimbursement

2025 Telehealth CPT Codes

The most commonly used telehealth codes in 2025 include:

Evaluation and Management (E/M) Codes

Specialty-Specific Telehealth Codes

• Psychiatry: 90785-90899 series
• Physical Therapy: 97161-97164
• Nutritional Counseling: 97802-97804
• Chronic Care Management: 99490, 99439

Essential Modifiers for Telehealth Billing

Using the correct modifiers is critical for proper telehealth reimbursement:

• 95: Synchronous telemedicine service (most common)
• GT: Via interactive audio/video (some Medicare plans)
• GQ: Asynchronous telehealth (store-and-forward)
• FQ: Audio-only communication
• POS 02: Place of service code for telehealth

Payer-Specific Telehealth Requirements

Each major payer has unique telehealth billing rules:

Medicare

• Coverage expanded through December 2025 under current legislation
• Requires GT or 95 modifier
• Audio-only allowed for mental health and certain other services
• Patient must be in an eligible originating site (with exceptions)

Medicaid

• Varies by state - check your state's Medicaid program
• Many states now cover audio-only visits
• Some require specific consent forms

Commercial Payers

• Most follow Medicare guidelines but with variations
• Many now permanently cover telehealth at parity with in-person visits
• Some require specific platform certifications

Documentation Best Practices

Proper documentation is essential for telehealth billing compliance:

1. Verify patient location: Document the patient's physical address
2. Record technology used: Note the platform and connection type (video/audio)
3. Obtain consent: Document patient consent for telehealth services
4. Detail time spent: Especially important for time-based codes
5. Note technical issues: Document any connection problems

Common Telehealth Billing Mistakes to Avoid

These errors frequently lead to denials:

• Incorrect POS code: Using the office POS instead of 02
• Missing modifiers: Forgetting required telehealth modifiers
• Unbundling services: Billing separately for services that should be bundled
• Inadequate documentation: Failing to document required telehealth elements
• Tech platform issues: Using non-compliant technology

Telehealth Billing Workflow Optimization

Streamline your telehealth billing process:

Pre-Visit

• Verify insurance coverage for telehealth
• Obtain necessary patient consents
• Confirm technology requirements

During Visit

• Document all required telehealth elements
• Note start/end times for time-based coding
• Record any technical difficulties

Post-Visit

• Apply correct codes and modifiers
• Include required documentation
• Track denials and adjust processes accordingly

State-Specific Telehealth Regulations

In addition to federal rules, be aware of state requirements:

• Licensure: Some states require special licenses for cross-state telehealth
• Prescribing: Rules vary for prescribing via telehealth
• Consent: Additional consent requirements in some states
• Private payer laws: Many states have telehealth parity laws

Emerging Telehealth Billing Trends

What's new in 2025 telehealth billing:

• Expanded RPM coverage: More payers covering remote patient monitoring
• AI-assisted coding: New tools to help select proper telehealth codes
• Behavioral health expansions: More covered services for mental health
• Specialty-specific codes: New codes for specialties adopting telehealth

Implementing a Successful Telehealth Billing Program

Follow these steps to optimize your telehealth billing:

1. Conduct a payer-by-payer review of telehealth coverage
2. Train all staff on telehealth billing requirements
3. Create cheat sheets for common scenarios
4. Implement pre-claim reviews for telehealth services
5. Monitor denial rates and adjust processes
6. Stay updated on regulatory changes

Conclusion

Telehealth billing doesn't have to be complicated when you understand the rules and implement systematic processes. By following these best practices, you can maximize reimbursement while maintaining compliance. Remember that telehealth regulations continue to evolve, so regular review of your billing practices is essential to avoid lost revenue and potential audits.