Telehealth has moved from a temporary convenience to a permanent part of how many practices deliver care. But virtual visits only support your revenue when they are coded and billed the way each payer expects. Small details, the wrong place-of-service code, a missing modifier, or an audio-only visit billed as audio-video, are enough to turn a legitimate encounter into a denial.
This quick reference pulls together the codes and rules that matter most for telehealth billing, so your team can submit clean claims the first time. Always confirm current requirements with each payer, since telehealth policies continue to evolve.
What Is Telehealth Billing?
Telehealth billing is the process of documenting, coding, and submitting claims for care delivered remotely through real-time audio-video, audio-only, or store-and-forward technology. It combines standard evaluation and management coding with telehealth-specific place-of-service codes and modifiers that tell the payer how and where the service was provided. Because commercial plans, Medicare, and Medicaid each define covered services differently, accuracy and payer awareness are essential.
Telehealth Place-of-Service (POS) Codes
The place-of-service code signals where the patient was located during the visit. Choosing the correct POS affects both reimbursement rate and whether the claim is accepted.
| POS Code | Description |
|---|---|
| 02 | Telehealth provided somewhere other than the patient's home |
| 10 | Telehealth provided in the patient's home |
| 11 | Office (used by some payers for telehealth to preserve in-person rates) |
Common Telehealth Modifiers
Modifiers clarify the technology used and the nature of the service. Using the right one, and matching it to your documentation, is one of the most common reasons telehealth claims succeed or fail.
| Modifier | Meaning |
|---|---|
| 95 | Synchronous telemedicine service via real-time audio and video |
| 93 | Synchronous telemedicine service delivered audio-only |
| GT | Interactive audio and video telecommunication (still required by some payers) |
| GQ | Asynchronous store-and-forward telecommunication |
| FQ | Service furnished using audio-only communication |
| FR | Supervising practitioner present via real-time audio and video |
| G0 | Telehealth for diagnosis or treatment of an acute stroke |
Common Telehealth CPT Codes
Most telehealth encounters use familiar evaluation and management codes, reported with the appropriate POS and modifier.
| CPT Code | Description |
|---|---|
| 99202-99205 | Office or outpatient visit, new patient |
| 99211-99215 | Office or outpatient visit, established patient |
| 99441-99443 | Telephone evaluation and management, established patient |
| 90791 | Psychiatric diagnostic evaluation |
| 90832 | Psychotherapy, 30 minutes |
| 90834 | Psychotherapy, 45 minutes |
| 90837 | Psychotherapy, 60 minutes |
| 99406 | Smoking and tobacco cessation counseling |
Common ICD-10 Diagnosis Codes Seen in Telehealth
- Z00.00 Encounter for general adult medical exam without abnormal findings
- F41.1 Generalized anxiety disorder
- F32.9 Major depressive disorder, single episode, unspecified
- E11.9 Type 2 diabetes mellitus without complications
- I10 Essential (primary) hypertension
- J06.9 Acute upper respiratory infection, unspecified
- R51.9 Headache, unspecified
Frequent Telehealth Denial Reasons
- Place-of-service code that does not match the payer's telehealth policy
- Missing or incorrect telehealth modifier
- Service not on the payer's list of telehealth-eligible codes
- Audio-only visit billed as if it were audio-video
- Patient location or originating-site rules not met
- Expired or changed temporary telehealth flexibilities
Best Practices for Clean Telehealth Claims
- Verify telehealth coverage and patient eligibility before the visit
- Document the technology used, patient location, and total time
- Keep a current payer grid of accepted POS codes and modifiers
- Confirm provider licensure in the patient's state
- Review remittance advice quickly and rework denials promptly
Payer-Specific Tips
- Medicare: watch published lists of covered telehealth services and the POS and modifier combinations tied to current rules.
- Medicaid: requirements vary widely by state, including which modifiers and originating sites are accepted.
- Commercial plans: many follow Medicare-style logic but set their own audio-only and behavioral health policies, so verify each plan.
When to Get Help
If telehealth denials are climbing or your team is spending hours reconciling payer rules, it may be time for specialist support. ClaimSphere RCM helps practices keep telehealth policies current, code visits accurately, and recover revenue that would otherwise be lost to preventable denials, so your virtual care gets paid as reliably as your in-office visits.
