Billing and Reimbursement

Telehealth services are billed using the same CPT codes as in-person visits when equivalent services are provided via real-time audio-video. Below, you will find a concise overview of applicable CPT/HCPCS codes, payer adoption notes, documentation standards, and key reference links to authoritative sources.


Place of Service (POS) Codes

Identify where the patient is located during the encounter.


Modifiers: Communicate how telehealth was delivered.

  • Modifier 95 – Synchronous telemedicine (real-time audio-video)
  • Modifier 93 – Synchronous audio-only communication

CPT Codes (Effective Jan 1, 2026)

  • 98000–98007 – Synchronous audio-video telemedicine visits
  • 98008–98015 – Synchronous audio-only telemedicine visits
  • 98016 – Brief virtual check-in (5–10 min)
  • View List of CPT/HCPCS Codes

Common Telehealth-Relevant Codes (Pharmacy/Clinical Use)

  • 99202–99215 – Outpatient E/M visits (telehealth audio-video)
  • 99453, 99454, 99457, 99458 – Remote Patient Monitoring (setup, data collection, management)
  • 98960–98962 – Patient self-management education/training (individual or group)

Resources


Documentation Essentials

  • Always document modality (audio-video vs audio-only), time spent, decision-making, consent, and technical issues.
  • Retain payer policy confirmation since adoption of new 98000 codes varies by state.

Developing a Billing Process

  • Map current workflow for patient encounters, documentation, and claim submission.
  • Define roles and responsibilities (who enters charges, reviews claims, follows up on denials).
  • Standardize documentation requirements (modality, time, consent, decision-making).
  • Select appropriate CPT/HCPCS codes, POS, and modifiers for each service type.
  • Integrate technology (EHR/billing software) to auto-populate codes, generate reports, and track claims.
  • Implement regular checks and audits for claim accuracy and compliance.
  • Develop escalation protocols for denied or rejected claims.

Training Staff on Billing

  • Provide clear policies, workflow guides, and step-by-step instructions.
  • Use real-life examples to demonstrate proper documentation and billing.
  • Offer hands-on practice exercises.
  • Highlight payer-specific rules (Medicare, commercial, telehealth).
  • Emphasize complete and accurate documentation to prevent denials.
  • Create a feedback loop for errors with timely coaching or refresher sessions.
  • Maintain ongoing updates on code, policy, or payer changes.
Telehealth


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