Telehealth Coding 2025 can seem like a bit of a wild jungle: different regulations exist between Medicare, commercial insurance payers, and Medicaid. To reduce claim denials, providers need to take care when traveling this path, following payer-specific guidelines and maintaining meticulous documentation as close to coding Adhere to Payer-Specific Coding Guidelines
Adhere to Payer-Specific Coding Guidelines
Medicare:
E/M Codes – usual in CPT E&M visit for one to two visits (99202-99316) through telehealth.
Modifiers: Add Modifier 93 to audio but not video services. Audio video is a union that doesn’t even need an adjective.
POS codes are home with patient (POS 10) and nonhome with patient (POS 02).
Commercial and Medicaid Payers:
CPT Coding: Some payers are adopting the new AMA telehealth codes (98000–98015). 4 Drag and drop each player for its codes.
Modifiers: The new G codes are for audio-video visits, the C.M.S. said, so if no is used reason for performing them those codes do not need to be appended with a modifier. Attach a modifier 95 to E/M codes. Modifier 93 would be for audio presentations only.
Implement Robust Documentation Practices
Is a verified record of what had to accompany it “” and prove out: verify “” that whatever the service was, (and) who one is entitled.
- Patient consent: Describe how the consent for telehealth was provided (eg, what were included in discussing potential benefits and risks afterwards).
- Type Initiate: Do not use audio only, Video or Audio.
- Time Billing: Time billing would be start and stop hours (or elapsed time) of the visit.
- Medical Necessity Identify the diagnosis of the patient, and what he or she will be treated for (in regard to the service requested).
- Location details: patient and provider location at service.
Streamline Billing and Claims Submission
- Quick billing, less rejected claims and quick pay-up:
- Eligibility Verification: Check patient’s insurance eligibility and coverage (if any) of services before every telehealth consultation.
- Get authorization: Others require prior authorization, for your own good and in some places because they didn’t have to years ago if you don’t want to get un-covered.
- When you file your claim Will this be within a certain amount of time when the Medical provider sends in or payer deadlines for submission of claims?
For a deeper look at how telehealth is reshaping claims and documentation, check out our full guide on How Telehealth Best Practices Impact Patient Care.
Educate and Train Staff Continuously
Yes, they should have access to the coding info and payer policies by now!
- Education: Keep up with CPT, modifier and documentation in services.
- Policy update: Payment Policy: Expect Billing Policy Updates Per Payer as We Add Them The policy update would be in line with the payer policies we recently added.
- Feedback loops: Again, there needs to be a means for reporting denials and possible remedial action back to employees.
Conclusion: Telehealth Coding 2025
Telehealth Coding 2025 is a means of saying: Hey, we’re ahead on payer policies, we’re doing everything we can to capture your work and upskill your staff.’ Applying these tactics will help you minimize denials and compel payers to pay your telehealth claims sooner.
At The Medicators, we help healthcare providers streamline their telehealth billing and coding processes with accuracy, compliance, and efficiency in mind. Our team ensures your claims align with the latest payer policies, so you can focus on patient care while we handle the billing complexity.
FAQs:
1. What are the key CPT codes for telehealth coding 2025?
Common E/M codes (99202–99316) apply, while new AMA telehealth codes (98000–98015) are used by some payers.
2. Which modifiers should be used for telehealth billing?
Use Modifier 95 for audio-video visits and Modifier 93 for audio-only services.
3. What POS (Place of Service) codes are used for telehealth?
Use POS 10 for home-based visits and POS 02 for non-home telehealth encounters.
4. How can I reduce telehealth claim denials?
Ensure accurate coding, verify eligibility, document consent, and follow payer-specific authorization rules.
5. Why is staff training important for telehealth billing?
Regular training keeps staff updated on CPT changes, modifier use, and payer-specific telehealth policies.
