Telehealth Billing Best Practices Navigating Codes, Modifiers, and Payer Policies

Telehealth Billing Best Practices: Navigating Codes, Modifiers, and Payer Policies

Introduction
Telehealth has rapidly transformed how healthcare is delivered. From primary care follow-ups to behavioral health visits and chronic care management, virtual care is now a permanent part of modern medical practice. However, while telehealth has made care more accessible for patients, it has also introduced new billing complexities for practices.
Billing correctly for telehealth services requires a clear understanding of codes, modifiers, payer-specific policies, credentialing requirements, and patient payment workflows. Without the right processes in place, practices risk delayed reimbursements, denied claims, and lost revenue.

This guide covers telehealth billing best practices to help practices navigate regulations and avoid common pitfalls. It demonstrates how automation solutions, such as MaxRemind, can streamline the process and enhance revenue collection.

Understanding Telehealth Billing Basics

At its core, telehealth billing follows the same principles as in-person billing – but with additional layers of compliance. Practices must ensure that the service provided is eligible for telehealth, that the correct codes and modifiers are applied, and that the payer’s specific policy is followed.
Telehealth billing typically involves:
  • CPT or HCPCS codes for the service rendered
  • Telehealth-specific modifiers
  • Place of Service (POS) codes
  • Verification of payer reimbursement rules
Each of these elements must align perfectly for claims to be reimbursed correctly.

READ MORE: The Impact of Telehealth on Medical Billing and Coding

Understanding Telehealth Billing Basics

Telehealth CPT & HCPCS Codes

Selecting the correct billing codes is the foundation of telehealth reimbursement. Most telehealth services utilize standard CPT codes, provided the service itself is eligible for virtual delivery.
Common Telehealth CPT Codes
Service Type CPT Code Examples
Office/Outpatient Visits
99202–99215
Behavioral Health
90832–90838
Virtual Check-Ins
G2012
Remote Evaluation
G2010
Chronic Care Management
99490, 99487
Remote Patient Monitoring
99453, 99454, 99457

Telehealth Modifiers Explained

Modifiers indicate that a service was provided via telehealth and are critical for claim acceptance.

Common Telehealth Modifiers
Modifier Description Common Use
95
Synchronous telehealth service
Medicare & commercial payers
GT
Interactive audio and video
Some legacy systems
GQ
Asynchronous telehealth
Store-and-forward services
FQ
Audio-only services
Medicare behavioral health
Using the wrong modifier, or omitting one entirely, is a leading cause of telehealth claim denials.

Place of Service (POS) Codes for Telehealth

POS codes tell payers where the service was rendered, even if the provider and patient were in different locations.

Common Telehealth Modifiers

POS Code Description
02
Telehealth is provided outside the patient’s home
10
Telehealth is provided in the patient’s home
11
Office (used by some payers with modifier 95)
Correct POS usage depends on payer requirements and has a direct impact on reimbursement rates.

Navigating Payer Policies and Variations

One of the biggest challenges in telehealth billing is that payer policies are not standardized. Each payer sets its own rules for:
  • Covered telehealth services
  • Eligible providers
  • Required modifiers
  • Reimbursement rates
Common Telehealth Modifiers
Medicare vs. Commercial Payers
Payer Type Key Considerations
Medicare Strict modifier & POS rules, frequent updates
Medicaid State-specific telehealth policies
Commercial Varies by plan, often mirrors Medicare
Staying current with these policies requires constant monitoring—something many practices struggle to manage manually.

Credentialing and Compliance Requirements

Even if a service is billed correctly, reimbursement can still be denied if the provider is not properly credentialed for telehealth.
Best practices include:
  • Verifying telehealth privileges with each payer
  • Ensuring providers are licensed in the patient’s state
  • Maintaining up-to-date credentialing records
Credentialing gaps often result in retroactive denials, which are difficult to appeal.
Credentialing and Compliance Requirements

Avoiding Telehealth Claim Denials

Telehealth claims are denied more frequently than in-person claims due to administrative errors rather than clinical issues.
Common Telehealth Billing Errors
Error Impact
Incorrect modifier
Claim rejection
Wrong POS code
Reduced or denied payment
Ineligible service
Non-covered claim
Missing documentation
Audit risk
Credentialing issues
Payment delays
Implementing automated claim checks and payer rule validation can dramatically reduce denial rates.

READ MORE: Best Practices for Denial Management: From Root-Cause to Recovery

Managing Patient Payments for Telehealth Services

Patient financial responsibility still applies to telehealth visits. Copays, deductibles, and coinsurance must be communicated clearly to avoid confusion and missed payments.
Best practices include:
  • Verifying benefits before the visit
  • Collecting copays digitally
  • Offering automated payment reminders
When patient payments are delayed, it directly affects cash flow – making efficient collections essential.
Managing Patient Payments for Telehealth Services

How MaxRemind Simplifies Telehealth Billing

Managing telehealth billing manually increases administrative burden and revenue risk. MaxRemind helps practices streamline every step of the telehealth revenue cycle.

With MaxRemind, practices can:

  • Validate telehealth codes, modifiers, and POS automatically
  • Align claims with payer-specific telehealth rules
  • Reduce denials before claims are submitted
  • Automate patient payment reminders and follow-ups
  • Gain visibility into telehealth reimbursement performance
How MaxRemind Simplifies Telehealth Billing
Instead of constantly reacting to billing issues, practices can focus on delivering quality virtual care – while MaxRemind ensures revenue stays on track.
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Building a Sustainable Telehealth Billing Strategy

Telehealth is no longer a temporary solution; it is a long-term care delivery model. Practices that succeed will be those that invest in accurate billing workflows, payer compliance, and automation.
By following telehealth billing best practices and leveraging tools like MaxRemind, practices can:
  • Minimize claim denials
  • Improve reimbursement timelines
  • Reduce administrative stress
  • Deliver a smoother experience for patients and staff
Telehealth should expand access – not create billing headaches. With the right systems in place, practices can transform virtual visits into a reliable and predictable source of revenue.

Streamline Telehealth Billing with MaxRemind

Avoid claim denials and improve reimbursement with automated code validation, payer-specific rules, and patient payment reminders.
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FAQs
What are the most common billing mistakes in telehealth services?

The most common telehealth billing mistakes include using incorrect CPT codes, applying the wrong telehealth modifier, selecting an improper Place of Service (POS) code, and billing for services that are not covered by a specific payer. Credentialing issues and incomplete documentation are also frequent causes of claim denials. Implementing automated billing checks can significantly reduce these errors.

Which modifiers are required for telehealth billing?

The most commonly used telehealth modifiers include Modifier 95 for synchronous audio-video services, GT for interactive telehealth on legacy systems, GQ for asynchronous services, and FQ for audio-only visits under certain Medicare guidelines. The required modifier depends on the payer’s policy, making it essential to verify requirements before claim submission.

How do payer policies differ for telehealth billing?

Telehealth billing policies vary widely across Medicare, Medicaid, and commercial insurance plans. Medicare has strict rules around modifiers and POS codes, Medicaid policies differ by state, and commercial payers often have plan-specific requirements. These variations make ongoing payer policy monitoring critical to ensure accurate billing and timely reimbursement.

Do providers need special credentialing to offer telehealth services?

Yes. Providers must be properly credentialed and enrolled with each payer to deliver and bill for telehealth services. This includes meeting telehealth-specific enrollment requirements and holding a valid licensure in the state where the patient is located. Failure to meet credentialing requirements can lead to retroactive claim denials.

How can practices improve telehealth revenue collection?

Practices can improve telehealth revenue collection by verifying patient benefits before visits, collecting copays digitally, using automated payment reminders, and ensuring claims are submitted the first time correctly. Leveraging revenue cycle automation solutions like MaxRemind helps reduce denials, speed up reimbursements, and maintain consistent cash flow.