Telehealth billing requires three core elements: (1) provider enrollment with payers as a telehealth-capable provider, (2) HIPAA-compliant, secure video/audio platform (Zoom for Healthcare, Doxy.me, Teladoc, similar), and (3) state medical licensure in the patient's location. Bill the same CPT codes as in-person care (99213-99215 for E/M, 90837 for therapy) with modifier 95 (synchronous audio-video) or place of service 02. Medicare covers 250+ telehealth services; commercial payers coverage varies. Patient must provide informed consent for telehealth and be informed of any technology limitations. Document patient location (city, state) in the EHR for each telehealth visit.
Bill telehealth using the same CPT codes as in-person visits. Add modifier 95 to indicate synchronous, audio-video telehealth. Alternatively, submit place of service 02 (telehealth provider location). Use modifier 95 for E/M (99213-95, 99214-95, etc.), therapy (90837-95, 90834-95), and specialty services (EKG interpretation via remote monitoring, etc.). If the visit is audio-only (no video), verify payer coverage—most require audio-video. Do not use modifier 95 for telephone-only or EHR messaging; these have separate codes (99443-99445 for established patient telephone visits, no modifier required). Document synchronous audio-video service delivery in the EHR.
Telehealth services do not require additional prior authorization beyond the service itself. Medicare and most commercial payers cover telehealth at the same reimbursement rate as in-person. However, verify the patient's coverage: some plans limit telehealth to certain diagnosis codes, certain specialties, or frequency limits. Office visit telehealth (E/M codes) is broadly covered. Therapy codes (90834, 90837) via telehealth have strong coverage post-pandemic. Specialty services (cardiology consultations, dermatology evaluation) are increasingly covered. Contact the payer to confirm coverage of specific telehealth services before providing the visit.
Telehealth codes are not bundled with in-person codes. Do not bill telehealth and in-person for the same patient the same day. If a patient is seen in-person and requires a quick telehealth follow-up within 24 hours (due to urgent issue), use separate dates and distinct documentation. Use modifier 95 with all telehealth codes. Do not combine modifier 95 with place of service 02 on the same claim—choose one method. When billing telehealth with other services (e.g., telehealth E/M + prescription refill), bundle the prescription refill into the E/M; do not bill separately.
Document the type of telehealth service: synchronous audio-video. Record the patient's location (city, state, ZIP code) at the time of the visit for geographic adjustments and compliance purposes. Note the technology platform used (Zoom, Doxy.me, etc.) and confirm HIPAA compliance. Document patient consent for telehealth prior to the visit (dated, documented in EHR). If technical issues occur, document them and the impact on the visit quality. Include the clinical note as you would for in-person care (chief complaint, history, exam findings, MDM, assessment, plan). Note any technology limitations (inability to perform certain physical exams). Document that the patient was appropriately identified and the connection was secure.
No. You must hold an active license in the state where the patient is located. Multi-state licensing or tele-specific licenses may be available in some states. Check your state medical board for telehealth-specific licensure rules. Cross-state practice without licensure violates state law and voids insurance coverage.
No. Medicare and U.S. insurance plans generally do not cover telehealth to international locations. Ensure the patient is located within a U.S. state where you are licensed. If a patient is traveling internationally, schedule in-person visits after they return to the U.S.
Either method is acceptable. Modifier 95 is used on the CPT code (99213-95). Place of service 02 is entered in the place of service field on the claim form. Medicare and payers accept both. Choose one method per claim and be consistent. Most billing systems prefer modifier 95 for clarity.
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