Audio vs Video: Why It Matters for Billing
The billing code, modifier, and reimbursement rate all change based on whether a telehealth visit uses synchronous video or audio-only telephone. Video visits (modifier 95) reimburse at parity with in-person visits under most payers. Audio-only visits use separate CPT codes (99441-99443) and reimburse at 50-75% of video rates. Billing a video code for an audio-only visit is a compliance risk — payers audit telehealth modality claims.
Video Visit Billing
- Use standard E/M codes (99202-99215) with modifier 95.
- Requires real-time audio AND video. The provider and patient must both be visible on screen for the clinical portion of the visit.
- Platform must be HIPAA-compliant. Standard phone FaceTime or Zoom (free version) do not qualify.
- Document: modality (synchronous audio-video), platform name, and patient consent for video visit.
Audio-Only Billing
- Use telephone E/M codes: 99441 (5-10 minutes), 99442 (11-20 minutes), 99443 (21-30 minutes).
- Medicare covers audio-only for established patients when video is not feasible (no internet access, disability, patient preference documented).
- Reimbursement: 99441 ~$15, 99442 ~$30, 99443 ~$50 under Medicare. Commercial rates vary.
- Behavioral health audio-only: Many payers cover 90834 and 90837 via audio-only with modifier 93. Check payer policy.
Common Denials
CO-50 occurs when the payer does not cover audio-only visits or the service is not on their audio-only eligible list. CO-16 flags when a video modifier (95) is used on an audio-only visit. CO-6 indicates the POS code does not match the visit type. See telehealth setup for configuration guidance.
Common Questions About Audio vs Video Billing
Can I bill a regular E/M code for a phone call?
No. Phone-based encounters must use telephone E/M codes (99441-99443) or, for behavioral health, therapy codes with modifier 93. Using 99213-95 for a phone call is incorrect billing and a compliance risk.
What if the video drops and we finish by phone?
If the video portion was the majority of the clinical encounter, bill the video code with modifier 95. If most of the visit was audio-only, bill the telephone code. Document the technical issue and the modality used for the clinical discussion.
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This reference is for informational purposes. Always verify against current payer policies, CPT guidelines, and CMS documentation. Last updated: 2026-04-06.