Introduction
Telehealth has entirely transformed our conceptualization of healthcare. Now, more than ever, patients can effortlessly communicate with their providers, whether they are in their living room or in a rural community many miles from the nearest clinic. Although this digital convenience is beneficial for patients, it has created a new level of complexity for healthcare providers.
In the case of telehealth billing, submitting a claim is not enough anymore. Now you are dealing with frequently shifting regulations and requirements of insurers, as well as novel technology platforms, all amid providing wonderful care. And let us be honest: one coding error or a missed modifier can lead to delays in payments or denials of claims or even serious harm to your revenue.
This is why knowing the ins and outs of telemedicine reimbursement is more critical. In this article, we’ll walk you through practical, up-to-date best practices that can help your team get reimbursed faster, reduce billing headaches, and keep your cash flow steady, so you can spend more time with patients and less time chasing down payments.
2. Understanding Telehealth Billing: The Basics
Before discussing the tips and strategies, let’s examine what telehealth billing involves.
Telehealth is a broad term that covers any healthcare services provided remotely using technology, such as video calls, phone consults, or even app-based messaging. Within that, telemedicine specifically refers to clinical services, such as virtual checkups, therapy sessions, or remote diagnostics.
Now, billing for these virtual visits isn’t as simple as in-person appointments. Every insurer—Medicare, Medicaid, or a private company—has its own set of rules, which can change frequently. To ensure you get paid correctly, you must use the right billing codes and follow each payer’s guidelines closely.
Here are a couple of key elements to get right:
- Place of Service (POS) codes like POS 02 (for telehealth delivered anywhere other than the patient’s home) or POS 10 (for services provided while the patient is at home) tell insurers where the care happened.
- Modifiers, such as 95 or GT, signal that the service was provided through telecommunication. These little code additions might seem minor, but they’re essential for approving the claim.
Skip one of these? Your claim might end up delayed—or worse, denied.
That’s why having a solid understanding of how telehealth billing works is the first step toward cleaner claims and faster reimbursements.
3. Challenges in Telemedicine Reimbursement
Telehealth has made healthcare more accessible and convenient, but getting paid for virtual visits can get tricky. One of the biggest challenges is that there’s no one-size-fits-all approach. Medicare, Medicaid, and private insurers all have rules that keep changing.
For example, some insurance plans only cover real-time video visits, while others might also accept audio-only calls. Some require patient consent before the appointment, others want detailed tracking of the time spent, or others insist on using specific telehealth platforms. These differences seem small, but they can seriously impact whether you get reimbursed.
Coding errors are another common stumbling block. It’s easy to accidentally use outdated CPT or HCPCS codes, forget the right modifier (like 95 or GT), or submit the wrong Place of Service code. Even tiny mistakes like these can delay payments or cause denials.
State laws add yet another layer of complexity. A telehealth service considered reimbursable in one state may not be recognised as such in another—a whole lot.
The first step in overcoming these challenges is being aware of them beforehand. With so many moving parts, many providers turn to specialized billing like Marvelous Medical Billing Services—experts who stay current with ever-changing policies and help ensure you get paid correctly.
4. Best Practices to Maximize Telehealth Reimbursement
Getting paid quickly and accurately for telehealth services isn’t impossible—it just takes focus, up-to-date knowledge, and some proven billing habits. Here are the key steps to help your practice nail telehealth billing and boost telemedicine reimbursement.
4.1 Know Your Payers’ Rules
Every insurance provider has its playbook for telehealth billing. Medicare regularly updates its list of covered services, and commercial insurers often have their timelines and rules.
- Some payers accept audio-only visits; others don’t.
- Consent rules can vary widely.
- The state and insurer decide whether telehealth visits are reimbursed at the same rate as in-person visits (reimbursement parity).
Verify coverage, accepted CPT codes, and documentation requirements with every payer before you submit any claims. By so doing, denied claims can be slashed, and payments accelerated.
4.2 Use the Correct CPT and HCPCS Codes
Billing telehealth visits means using the right codes for the services you provide. Some common CPT codes are:
- 99201–99215 for office or outpatient visits
- 99441–99443 for telephone evaluation and management
- G2025 for specific telehealth services under CMS guidance
Using outdated or incorrect codes is one reason claims are denied. Keep a current code list handy and ensure your billing team or software stays updated.
4.3 Apply Proper Modifiers and POS Codes
Modifiers and Place of Service (POS) codes let insurers know how and when the visit happened virtually.
- Modifier 95 indicates a real-time, interactive audio-video telehealth service.
- Some payers, especially Medicaid, still accept modifier GT.
- POS 02 means telehealth services delivered outside the patient’s home.
- POS 10 signals telehealth provided in the patient’s home—a newer Medicare option.
Matching these codes correctly to the service and payer expectations is critical. Even small mistakes here can mess up your reimbursement.
4.4 Maintain Thorough Documentation
Good documentation isn’t just a formality—it’s essential for compliance and getting paid. Always make sure to include:
- Where the patient and provider were located
- The date and time of the virtual visit
- What telehealth platform was used (Zoom, Doxy.me, etc)
- Patient consent (verbal or written)
- Details about the medical decisions, treatment, or advice given
Poor documentation is a common reason claims get denied or flagged during audits.
4.5 Train and Update Your Billing Staff
Telehealth billing differs from in-person visits, so regular training is a must. Your team needs to be up to speed on:
- Which codes and modifiers to use for each payer
- How to track and report time-based services properly
- What telehealth services are reimbursable in different states
Setting up monthly training sessions or quick updates, especially after big policy changes, can save a lot of headaches.
4.6 Outsource to Experts Like Marvelous Medical Billing
So, let us be honest: telehealth billing can be daunting when you have to do it independently. Among all the payer variants, compliance regulations, and due dates, one can overlook revenue without even noticing it.
This is why many practices prefer to outsource their billing to reliable experts such as Marvelous Medical Billing. Their team stays ahead of all the latest telehealth billing changes, handles claim submissions and follow-ups, and helps ensure you’re paid what you deserve. With their expertise and technology, you can focus more on your patients and less on paperwork.
5. Tools and Technology to Improve Billing Accuracy
Investing in the right technology is one of the smartest moves to boost the accuracy and speed of your telehealth billing. From scheduling appointments to submitting claims, modern software takes a lot of the guesswork and manual work off your plate—helping reduce errors, cut down denials, and get your reimbursements faster.
Look for a telehealth platform that integrates well with your Electronic Health Record (EHR) system. The best ones have built-in billing features that automatically capture important details—like visit notes, patient consent, time spent, and diagnosis codes—so your team isn’t stuck entering data by hand, often where mistakes happen.
Another handy tool is claim scrubbing software. These systems double-check each claim before it goes out, catching missing modifiers, incorrect codes, or services that a specific insurer doesn’t cover. This means fewer rejected claims and quicker payments.
Many practices also use automated eligibility verification to confirm insurance coverage before each telehealth visit. Knowing upfront what services will be reimbursed saves time and frustration for everyone.
Even if you outsource your billing to a trusted partner like Marvelous Medical Billing, technology ensures that claims are accurate and paid promptly. When you combine human expertise with smart tools, telemedicine reimbursement becomes less of a headache and more of a reliable, predictable process.
6. Future Outlook: What’s Next for Telehealth Billing?
The future of telehealth billing looks bright, but it’s also unpredictable. During the COVID-19 pandemic, emergency rules quickly expanded coverage and reimbursement for virtual visits. Many of those temporary changes are being reviewed, adjusted, or extended by government and private payers.
Medicare, for instance, is making some of the pandemic flexibilities permanent, like continuing to cover mental health sessions and chronic care management via telehealth. However, policies are still shifting, so healthcare providers need to stay alert and flexible.
State laws are also changing, affecting things like licensure portability (the ability to practice across state lines), coverage for audio-only visits, and whether telehealth is paid at the same rate as in-person care. Keeping a close eye on these updates will help your practice adapt and succeed.
One thing’s clear: telehealth is here to stay. With a changing landscape will come changing billing rules and practices. To be compliant and profitable in this new world of healthcare, it will be necessary to partner with billing experts and embrace technology.
7. Final Thoughts: Turning Telehealth Billing into a Strength
Telehealth has become a cornerstone of healthcare, and billing for these virtual visits is no longer just an afterthought—it’s a critical part of keeping your practice financially healthy. As a result of perfecting the most excellent telehealth billing practices, including applying the correct codes and modifiers and taking advantage of intelligent technology, you can decrease denials, optimize revenue, and concentrate on what truly matters most: the care of the patients.
Managing the dynamic payer policies and compliance regulations is not simple. A reliable partner, such as Marvelous Medical Billing, can greatly help. Their expertise helps you confidently handle the complexities of telemedicine reimbursement so you don’t have to worry about getting paid.
In today’s healthcare world, getting reimbursed shouldn’t be harder just because the care happens online. By setting up the right systems and strategies now, you’re building a foundation for your practice’s success well into the future.