Telehealth Coding: The Key to Accurate Reimbursement in Modern Healthcare

Telehealth has reshaped how care is delivered — bringing convenience to patients and flexibility to providers. But behind every virtual visit lies one critical component that determines whether providers get paid correctly: telehealth coding.

In 2025 and beyond, the landscape of telehealth billing continues to evolve with changing CPT codes, modifiers, and payer-specific rules. Understanding these nuances is essential to minimize denials, ensure compliance, and protect your practice revenue.

Why Telehealth Coding Accuracy Matters

Even small coding mistakes can cause major revenue disruptions. Since telehealth combines both traditional E/M services and virtual visit guidelines, coders must ensure each claim reflects:

• The correct place of service (POS)

• The appropriate telehealth modifiers (95 for audio-video, 93 for audio-only)

• The accurate CPT or HCPCS codes for the visit type

Failing to apply the right combination can lead to denials or compliance flags — especially as payers tighten policies on telehealth reimbursement.

Key Coding Components for Telehealth in 2025

1. E/M Codes and CPT Updates
   Common codes like 99202–99215 still apply to most telehealth visits, but some payers are adopting AMA’s new telehealth-specific codes (98000–98015). Always verify which codes your payer accepts.

2. Modifiers

   • Modifier 95 – Used for real-time, audio-video interactions.

   • Modifier 93 – Used for audio-only services.

3. Place of Service (POS)

   • POS 10 – Patient’s home

   • POS 02 – Other locations (e.g., clinic or office setting)

Proper pairing of these codes ensures clarity, compliance, and smooth claims processing.

Documentation That Supports Coding

Accurate documentation is the backbone of compliant telehealth billing. Providers must record:

• Patient consent for telehealth

• Time spent and method used (audio/video)

• Diagnosis and treatment justification

• Patient and provider location

Every note should tell the full story of the encounter — showing medical necessity, continuity of care, and payer compliance.

Common Coding Challenges in Telehealth

• Using incorrect modifiers for hybrid visits (part in-person, part virtual)

• Missing prior authorization for Medicaid or private insurance

• Not documenting time and method of communication properly

• Submitting the wrong POS code for remote sessions

Avoiding these errors can drastically reduce your claim rejection rates and audit risks.

The Medicators: Your Telehealth Billing & Coding Partner

At The Medicators, we help healthcare practices simplify telehealth billing through precision coding, compliance audits, and real-time claim monitoring. Our team ensures every modifier, CPT code, and documentation line aligns perfectly with payer rules — so your clinic gets paid faster, without stress.

To learn more about improving patient care alongside better coding practices, check out this related post:
👉 The Impact of Telehealth Best Practices on Patient Care

Conclusion

Telehealth coding isn’t just about billing — it’s about protecting the sustainability of virtual care. With ongoing regulatory changes, every detail matters — from the code you use to the documentation you attach.

By partnering with The Medicators, providers can focus on care while we handle compliance, denials, and evolving payer rules — ensuring that your telehealth program remains profitable, compliant, and future-ready.