Telehealth billing has been one of the most talked-about topics in healthcare over the last five years. For many providers, the first question that comes to mind is: Which modifier do I use to get paid? While modifier 95 is often seen as the key to reimbursement, the reality is that telehealth billing in 2025 is far more complex than just attaching the right modifier. Healthcare providers and practice managers need to navigate evolving payer policies, CPT® code eligibility, place of service (POS) reporting, and documentation standards. In this article, we’ll break down the essential components of telehealth billing, explain the role of modifiers, and highlight what you need to know to avoid denials and secure proper reimbursement.
Understanding Telehealth Billing Basics
At its core, telehealth billing refers to the process of submitting claims for healthcare services delivered remotely using technology such as video conferencing, secure platforms, or telephonic consults. While the clinical encounter may feel straightforward, billing for it requires close attention to:
- CPT® and HCPCS code eligibility (not all codes are billable via telehealth).
- Modifiers (such as 95 or GT, depending on payer).
- Place of Service (POS) codes (to indicate the encounter happened virtually).
- Payer-specific rules (commercial, Medicare, and Medicaid programs can differ).
Why Modifiers Matter in Telehealth Billing in 2025
Modifiers serve an important role: they signal to the payer that the service was delivered remotely rather than in-person.
- Modifier 95: Commonly used for real-time, interactive audio-video telehealth encounters.
- GT Modifier: Still accepted by some Medicaid programs and regional payers.
- Other Modifiers: In limited cases, payers may require different designations for telephonic visits or asynchronous services.
Note that modifiers alone do not guarantee reimbursement. They are only part of a larger framework that includes correct CPT coding, POS codes, and payer guidelines.
Place of Service (POS) Codes in Telehealth
Just as important as modifiers are POS codes, which identify where the service took place. In telehealth billing, commonly used POS codes include:
- POS 02: Telehealth provided other than patient’s home.
- POS 10: Telehealth provided in the patient’s home.
Medicare and commercial payers often require POS codes in combination with modifier 95 to correctly process the claim. Reporting the wrong POS can easily trigger a denial, even if the modifier is correct.
CPT® Codes and Telehealth Eligibility
Not every CPT® or HCPCS code is payable via telehealth. CMS publishes an updated list each year of codes that are approved for telehealth reimbursement under Medicare. Private insurers often adopt similar lists but may have their own variations.
- Evaluation & Management (E/M) visits are among the most commonly billed telehealth codes.
- Behavioral health and mental health codes have expanded telehealth eligibility.
- Procedural codes are far less likely to be approved for telehealth.
Many claim denials happen because a code was billed via telehealth even though it isn’t eligible. Always verify with payer resources before submitting.
Common Reasons Telehealth Claims Are Denied
Despite providers using modifiers correctly, telehealth claims can still be denied. Here are some of the most frequent denial reasons we see:
- Incorrect POS reporting: Using POS 11 (office) instead of 02 or 10.
- Non-eligible CPT® codes: Billing for codes not covered under telehealth.
- Payer-specific rules ignored: Some payers still require the GT modifier or restrict telephonic services.
- Documentation gaps: Missing details such as patient consent, platform used, or time spent.
- Outdated policy knowledge: Failing to keep up with annual CMS and insurer updates.
Medicare vs. Commercial Payer Telehealth Billing
Medicare has gradually expanded telehealth coverage, particularly for behavioral health and rural access. However, commercial payers may take a stricter stance, with variations in:
- Accepted modifiers.
- Coverage for asynchronous care.
- Frequency limits.
- Patient location rules.
This makes it critical for practices to check payer bulletins regularly. A claim that passes with Medicare may not be payable with a commercial plan, and vice versa.
Best Practices for Telehealth Billing in 2025
To reduce denials and improve reimbursement, practices should adopt a structured approach to telehealth billing:
- Verify code eligibility before scheduling and billing.
- Use correct POS codes (02 vs. 10 depending on patient’s location).
- Apply modifiers accurately (95, GT, or payer-specific requirements).
- Document thoroughly, including patient consent and encounter details.
- Track payer updates – especially annual CMS telehealth updates.
- Audit denied claims to identify trends and fix recurring errors.
Why Outsourcing Telehealth Billing Can Help
Telehealth billing demands constant updates, coding accuracy, and payer-specific knowledge. Many providers find it challenging to keep up while also managing patient care. This is where partnering with a specialized medical billing company can make a real difference. At Medisys, our team stays current on CMS and commercial payer telehealth guidelines, ensures accurate use of modifiers and POS codes, and helps providers minimize denials. Whether you are billing for behavioral health, primary care, or specialty telehealth visits, we provide the expertise needed to keep your revenue cycle running smoothly. Contact us today to know more about our telehealth billing services.
Disclaimer: The CPT® codes and modifiers discussed in this article are copyrighted by the American Medical Association (AMA). The information provided here is for educational purposes only. For the most accurate and updated coding guidance, please refer directly to the AMA and CMS official resources.
