Telemedicine and Telehealth Billing Services

Telehealth rules change often, and they differ by payer. Medicare, Medicaid and commercial plans each decide which services count, how the visit must be delivered and which modifier or place of service to use. A claim that works for one plan may be denied by the next.

That is why telemedicine billing needs close attention. Practices must record how the visit happened, where the patient was and which state the patient was in. Westmont Revenue Partners connects telehealth providers with vetted billing experts who track these rules, so claims match the visit that took place and are less likely to be denied for technical reasons.

Who this is for

• Primary care and specialty practices that offer virtual visits
• Telehealth-only practices and virtual care companies
• Behavioral health providers who see patients remotely
• Providers who see patients in more than one state
• Practices that add remote monitoring to their services

What gets billed

• Video visits for new and established patients
• Audio-only visits, where payers allow them
• Brief virtual check-ins
• Online messages and digital evaluations
• Telehealth behavioral health sessions
• Remote patient monitoring
• Chronic care management delivered remotely
• Telehealth wellness visits
• Interprofessional consultations
• Telehealth follow-up after hospital stays
• E-visits for patients who start a request online

Commonly billed codes

Code	Type	What it covers
99213	CPT	Established patient visit, low level, may be done by video
99214	CPT	Established patient visit, moderate level, may be done by video
99204	CPT	New patient visit, moderate level, may be done by video
G2012	HCPCS	Brief virtual check-in by phone or video
99421	CPT	Online digital evaluation, patient message, short time
99422	CPT	Online digital evaluation, patient message, mid time
99423	CPT	Online digital evaluation, patient message, longer time
G0439	HCPCS	Medicare subsequent annual wellness visit, may be done by telehealth
99490	CPT	Monthly chronic care management by clinical staff
Modifier 95	Modifier	Service delivered by real-time video and audio
Modifier 93	Modifier	Service delivered by audio only
POS 02	Place of service	Telehealth, patient not at home
POS 10	Place of service	Telehealth, patient at home

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in telemedicine

Changing Medicare rules. Medicare telehealth flexibilities have been extended by Congress several times, with the latest extension reported to run through 2027. Billers watch for updates and confirm the status each year.

Modifiers and place of service. Payers differ on whether they want modifier 95, a place of service of 02 or 10, or both. Billers keep a payer chart and update it when policies change.

Audio-only visits. Audio-only is allowed by some payers for some services, with its own modifier. Billers confirm the plan allows it and that the note says why video was not used.

Out-of-state patients. Licensing rules depend on where the patient is. Billers record patient location at every visit so the practice can show it was licensed and credentialed there.

Documentation of consent and technology. Many payers expect notes to include the visit method, locations and consent. Billers provide templates that cover these items.

Code changes. CPT added telehealth codes in recent years, and not every payer accepts them. Billers check payer policy before switching codes.

Originating site and rural rules. Some Medicare rules depend on where the patient is and which service is provided. Billers review these conditions before claims go out.

How Westmont can help

• Matching you with vetted billing experts who track telehealth payer rules
• End-to-end revenue cycle support for virtual and hybrid practices
• Denial management for modifier, place of service and coverage denials
• Credentialing and multi-state enrollment support
• Reporting that separates telehealth and in-person revenue

Frequently asked questions

Does Medicare still cover telehealth?

Medicare has covered many telehealth services under temporary flexibilities that Congress has extended more than once, and recent reports indicate an extension through 2027. Rules can change, so check current CMS and MAC guidance before you rely on any one policy.

What is the difference between POS 02 and POS 10?

Place of service 02 means telehealth when the patient is somewhere other than their home. POS 10 means telehealth when the patient is at home. Payers differ in how they pay each, and some also want a modifier. Confirm each payer's policy.

Do I need modifier 95 on telehealth claims?

It depends on the payer. Some commercial plans require modifier 95 to show real-time video. Medicare has its own instructions that may call for a place of service instead. Check each payer's current policy rather than assuming one rule applies.

Can I bill audio-only visits?

Some payers cover audio-only visits for certain services and require a specific modifier. Medicare has rules on when audio-only is allowed. Document why video was not used and confirm coverage with each payer before billing. Keep a record of the call length and what was discussed.

Can I see patients in other states by telehealth?

That depends on licensing in the state where the patient is during the visit, and on the payer's credentialing rules. Some states offer compacts or exceptions. Get legal advice, record patient location at every visit and verify payer network rules. Payers may also limit which states a provider is credentialed to serve.

Related billing services

• Family Medicine
• Internal Medicine
• Psychiatry
• Psychology
• Urgent Care
• Concierge / Direct Primary Care