Evolving Telehealth Coding Practices Post-Pandemic: Ensuring Compliance and Maximizing Reimbursement for Remote Medical Services

Telehealth grew quickly during the COVID-19 pandemic because temporary rules made billing easier. These rules allowed more locations for patients, more types of services, and even audio-only telehealth visits with simpler paperwork and billing.

Now that the public health emergency is ending, many of these temporary rules are ending or becoming stricter in 2025. Medicare, Medicaid, and private insurers are bringing back stricter policies. Medical practices need to update their telehealth billing to keep up.

Key Challenges:

• Evolving Payer Regulations: Medicare and Medicaid are limiting telehealth coverage again. They are bringing back rules about where the patient must be located during the visit. States have different Medicaid telehealth rules. Some allow audio-only visits; others do not. Private insurers have their own rules and payment rates based on contracts.

• Use of Proper CPT Codes and Modifiers: Using the right codes is very important to get paid. Codes 99202 to 99215 cover video visits with both sound and picture. New e-visit codes 98000 to 98002 will start in 2025 for virtual care done at different times. Audio-only visits use codes 99441 to 99443 with modifier 93. Medicare will mostly stop paying for these audio-only codes in 2025 except for mental health and substance use cases.

• Place of Service (POS) Codes: These codes show where the service happened. POS 02 means telehealth done from places like clinics. POS 10 means the service happened in the patient’s home. POS 10 usually pays more.

• Documentation Demands: Providers must keep good records. This includes why the visit was needed, permission from the patient, what happened during the visit, and its time. This is important to follow privacy laws and avoid rejected claims.

• Licensing and Credentialing Issues: Healthcare providers must be licensed in the state where the patient lives. If not, claims can be denied and payments delayed.

Because of different payer rules and state laws, telehealth billing can be very confusing. Medical staff need to watch for changes and train billing teams well to reduce claim denials and low payments.

Medicare, Medicaid, and Private Payers: What Medical Practices Should Know

Medicare: In 2023, Medicare made some temporary telehealth rules permanent. This helped remote care like evaluation and management visits, mental health counseling, and remote patient monitoring (RPM). But some rules from the pandemic will end in 2025. For example, Medicare will mostly stop paying for audio-only visits using codes 99441 to 99443 except for behavioral health.

Payments rely on using the correct POS codes and modifiers. For video visits, Medicare needs modifier 95 and POS codes 02 or 10. Using wrong codes often causes claim denials.

Medicare also requires RPM providers to be enrolled as Medicare Part B providers. Billing for RPM uses codes 99453 and 99454. Providers need a doctor’s order to start these services.

Medicaid: Medicaid telehealth rules differ by state. Some states pay for audio-only visits; others do not. Medicaid often has specific rules for CPT codes, POS codes, and modifiers. Providers must check state rules and update billing as needed.

Private Insurers: Private insurers have many different rules on telehealth. Some pay the same for telehealth as in-person visits. Others pay less or have limits. Provider licensing and contracts affect claims. It is important to check private insurance rules often.

Some private programs allow patients to pay directly for telehealth services like RPM and chronic care management, adding more ways to earn money besides insurance.

Coding and Modifier Notables for Effective Telehealth Billing

Using the right CPT codes and modifiers is key to getting paid for telehealth.

• CPT Codes for Telehealth Video Visits: Codes 99202 to 99215 cover office and outpatient visits done by live video for new and returning patients.

• Audio-Only Visits: Codes 99441 to 99443 cover phone evaluation and management services. Medicare will mostly stop paying for these in 2025 except for some behavioral health cases.

• Virtual and Digital Visits (E-Visits): New codes 98000, 98001, and 98002 start in 2025 for online communications like patient portal messages or secure emails, based on how much time is spent.

• Modifiers: Modifier 95 is for live video telehealth visits. Modifier GT is used sometimes in Medicaid policies. Modifier 93 is for phone-only visits.

• Place of Service Codes (POS): POS 02 means telehealth done from non-home sites like clinics. POS 10 means telehealth done from the patient’s home. POS codes affect payment amounts and compliance. POS 10 often pays more in Medicare.

Mistakes with codes and modifiers cause many claim rejections. Accurate billing is always important.

Telehealth Documentation Essentials

Good documentation proves that the medical service was needed and supports payment.

• Show patient gave permission for telehealth.

• Record details of the visit type (live video or audio only).

• Note start and end times, important for time-based billing codes.

• Include clinical notes like findings, diagnosis, and treatment plans.

• Document use of any remote patient monitoring devices and their data.

• Follow specific state and payer documentation rules.

Complete records help avoid audits, claim denials, and payment delays. Missing details cause many problems.

Remote Patient Monitoring and Chronic Disease Management

Remote Patient Monitoring (RPM) has grown in telehealth. It helps patients with chronic illnesses like asthma, COPD, diabetes, and mental health issues. The CDC says most U.S. healthcare spending is on chronic and mental health conditions, so RPM is important.

Medicare lets providers bill for RPM under Part B if they are enrolled and have a doctor’s order. Codes 99453 and 99454 cover device setup, data transmission, and monitoring. Medicaid and private payers also pay for RPM but with different rules.

To make RPM work well, clinical staff, billing teams, and healthcare providers need to work together. Care plans and regular chart reviews help meet billing and clinical rules.

AI and Workflow Automation in Telehealth Billing: The Emerging Standard

Telehealth billing is complex. Technology like automation and artificial intelligence (AI) helps providers handle it.

AI-Powered Coding and Claim Management
Platforms use AI to pick the right billing codes, modifiers, and location codes based on changing payer rules. This reduces mistakes that cause claim denials and lower payments. AI can also check claims before they are sent out to catch errors.

Automated Eligibility Verification and Denial Management
AI tools check insurance coverage in real time. This lowers the chance of claims that cannot be paid. Automated systems alert scheduling staff about coverage limits before visits.

Mobile Voice Recognition and Documentation
AI voice tools help doctors document telehealth visits quickly during or right after appointments. These tools can link to electronic health records, making billing more accurate and faster.

Predictive Analytics
AI can spot claims likely to be denied, based on past data. This helps fix problems before submitting claims.

Case Evidence
Studies of telehealth providers in the U.S. show AI helped reduce billing mistakes by about 40% and increased claim approvals by 22%. Some platforms report up to a 75% faster billing process, improving cash flow for telehealth services.

Compliance Monitoring
AI also gives automatic updates about the latest Medicare, Medicaid, and private insurance rules. This helps billing teams stay current and lowers audit risks.

Planning for the Future: Preparing Telehealth Billing Teams

To keep up with rules and get full payments for telehealth, medical practice leaders should:

• Keep learning about telehealth coding, modifiers, and rules.

• Train staff on changing Medicare, Medicaid, and private payer billing policies.

• Use AI billing and documentation tools that work with current electronic health record systems.

• Encourage teamwork between clinical workers and billing specialists.

• Verify provider licenses and telehealth credentials in patient states.

• Regularly review claims and denied bills to find ways to improve.

Telehealth billing rules will keep changing due to new laws, technology, and payment models. Practices that adjust quickly and use technology will have fewer denials and better payments.