Telehealth Medical Billing: A Practical Guide for Practices

Telehealth medical billing looks simple — same visit, same code, different room — until the denials arrive. This guide covers the place-of-service and modifier basics, the audio-only distinction that decides many claims, and why the only safe rule in telehealth billing is to verify each payer's current policy.

Doctor providing a telehealth consultation on a laptop

What Counts as Telehealth for Billing Purposes

For billing, telehealth is not one thing. A visit can be synchronous audio-video (a live two-way video encounter), audio-only (a telephone visit with no video), or asynchronous (information exchanged without a live interaction, such as a portal-based review). Some remote services, like remote physiologic monitoring, are billed under their own code families entirely and should not be confused with a telehealth visit at all.

The claim has to describe what actually happened. The codes, place of service and modifiers on the claim together tell the payer the modality of the visit, where the patient was, and what kind of service was delivered. When those elements disagree with each other — or with the documentation in the chart — the claim is exposed, even if the care itself was entirely appropriate.

Place of Service: Where the Visit "Happened"

Place-of-service (POS) codes tell the payer where the patient was located during the encounter. Two codes do most of the work in telehealth medical billing:

POS 02 — Telehealth provided other than in the patient's home. The patient was at a location other than their home — for example, at another facility or a workplace — when the remote visit took place.
POS 10 — Telehealth provided in the patient's home. The patient was home during the visit, which is the most common scenario for routine telehealth.

Using the right one matters more than it may appear. POS interacts with how some payers price the claim and with their coverage rules, and a POS that contradicts the rest of the claim — or the note — is a common, quiet reason for denials and downcoding. The POS should come from the documentation of where the patient actually was, not from a default the biller applies to every telehealth claim.

Modifiers That Flag a Telehealth Claim

Modifiers are how the claim announces its modality. The ones practices encounter most often:

Modifier 95 — a synchronous audio and video telehealth service. Appending it tells the payer the visit was a live, real-time video encounter.
Modifier 93 — a synchronous audio-only service. This is the flag for a telephone visit where no video was used.
Modifier GT — an older interactive audio-video modifier that some payers and programs historically used; it still appears in certain payer instructions, which is why billers encounter conflicting guidance.

The trap is assuming one combination works everywhere. Some payers want the modifier, some rely on the POS code alone, and some want both — and the expected combination can differ between a payer's medical and behavioral health lines. Behavioral health billing adds its own payer-specific conventions on top. The modifier set on the claim should match that payer's current telehealth billing instructions for that service, verified in advance rather than copied from a previous claim.

Audio-Only vs. Audio-Video: The Distinction That Decides Payment

Whether a visit used video is frequently the fact the whole claim turns on. Many payers cover audio-only visits for certain services — behavioral health is the most common example — while restricting telephone visits for others or excluding them entirely. Eligibility also differs by code: a payer may accept audio-only for established-patient visits but not for a new-patient evaluation, or cover audio-only only when the patient could not use video.

Because of that, the chart note carries unusual weight in telehealth. It should state plainly:

The modality used — video, or audio-only, and why if video was not possible
That the patient consented to a telehealth visit
Where the patient was located (which also supports the POS code)
The time spent, where the code selection depends on time
Who participated and the clinical content of the encounter

If the note does not establish the modality, the biller is guessing — and a claim built on a guess tends to be denied or, worse, paid and later recouped on audit.

Why Every Payer Has Its Own Telehealth Rules

Practices often ask for "the telehealth rules," and the honest answer is that there is no single set. Medicare maintains its own telehealth policies and list of covered services. State Medicaid programs set theirs independently, so coverage can change at a state border. Commercial payers write their own policies contract by contract, and those policies have been revised repeatedly in recent years. Two claims for the same service, same day, same provider can follow different rules because the patients carry different coverage.

The practical consequence: telehealth coverage and billing requirements should be verified per payer, per service, before the schedule fills with visits that may not pay. Eligibility checks for telehealth patients should confirm not just that coverage is active, but that the specific service is covered when delivered remotely, by that modality. That single habit prevents the most expensive category of telehealth denial — the visit that was never payable in the first place.

Where Telehealth Claims Get Denied

The denial patterns repeat across practices:

POS and modifier mismatch — a video modifier paired with the wrong place of service, or a missing modifier the payer requires
Audio-only billed where video was required — or video documented but never supported by the note
Modality not documented — the note describes the medicine but never says how the visit was conducted
Coverage never verified — the service was not a covered telehealth service under that patient's plan
Wrong code family — telephone visit codes used where the payer expects the standard visit code with a telehealth modifier, or the reverse

Most of these are front-end errors, not clinical ones. They are preventable with a short pre-claim check: modality confirmed, POS matched to the note, modifier set matched to the payer, coverage verified. Practices that build that check into scheduling and charge review see telehealth claims behave like ordinary claims — which is the goal.

Frequently asked questions

Which place-of-service code should we use when the patient is at home?

Generally, POS 10 identifies a telehealth visit where the patient is in their home, while POS 02 covers telehealth delivered with the patient at another location. The correct choice follows the documentation of where the patient was, and individual payers may add their own instructions on top.

Does audio-only count as telehealth for billing?

Yes, audio-only is a recognized form of telehealth, and modifier 93 exists to identify it. Whether a specific audio-only service is covered, however, depends on the payer and the service — many payers cover audio-only for some services, particularly in behavioral health, and not for others. Verify before the visit, not after the denial.

Do all payers require modifier 95 on video visits?

No. Modifier 95 is widely used, but requirements vary: some payers want it, others rely on the place-of-service code, and some specify a different combination. The safe practice is to confirm each payer's current telehealth billing instructions for the services you bill most and build those rules into your charge review.

Get a Free Consultation See All Billing Services