Virtual Care Billing & Telehealth CPT Codes Guide 2025 | Maximize Reimbursement

Introduction

In the post-pandemic technology, virtual care billing has grown to be an essential thing in scientific practice. With telehealth changing a great portion of in-person visits, accurate billing is critical. Providers want to master offerings like telehealth billing codes, telemedicine reimbursement rates, telehealth claims submission, and telehealth CPT codes—in particular in mental health. Understanding these factors ensures sales are maximized and claim denials are minimized. In this search engine optimization-optimized, human-written guide, we'll discover the essentials little by little.

What is virtual medical billing?

Virtual care billing refers back to the technique of coding, documenting, submitting, and reimbursing healthcare services added remotely through telehealth or telemedicine systems. Unlike traditional in-person visits, telehealth claims ought to encompass:

• Specific CPT/HCPCS codes that reflect the telehealth service.

• Place of Service (POS) codes (e.g., POS 02 or 10).

• Modifiers such as 95, GT, or 93 to indicate modality.

Accurate coding guarantees carriers get paid fairly and keep away from denials. Virtual visits can range from easy check-ins to complicated continual care and behavioral health follow-ups. The complexity of billing varies primarily based on provider type, payer (Medicare, Medicaid, private insurers), and location.

Telehealth Billing Codes Overview

Telehealth billing codes include CPT and HCPCS codes used by telemedicine providers:

• Office/outpatient assessment and control codes (99202–99215)

• Telehealth-particular HCPCS: G2010, G2012 (or new replacements like 98016)

• Audio-best E/M codes (98008–98015) introduced in 2025 for telephone encounters

• Remote Patient Monitoring (RPM)—e.G., 99453, 99454, 99457, 99458

• Remote Therapeutic Monitoring (RTM)—e.G., 98975, 98976

• Behavioral Health and Chronic Care management: APCM G0556, CCM codes

New 2025 CPT Telehealth Codes

2025 introduced distinct CPT telehealth codes:

These mimic in-office E/M codes (99202–99215) and use MDM or total time for code level.

Telehealth Modifiers & Place of Service

To denote modality and location:

• Modifier 95: synchronous audio-video (many commercial payers)

• Modifier GT: telemedicine via audio/video

• Modifier 93: synchronous audio-only (required by Medicare for audio-only visits)

• POS 10: patient at home

• POS 02: patient not at home

Telemedicine Billing Guide by Payer

Medicare

Medicare extended telehealth flexibilities through September 30, 2025, allowing:

• Audio-only and audio-video telehealth

• Use of near-person locations (FQHC, RHC)

• Continue RPM, hospice recertification, behavioral health

Key points:

• Use POS 10 (home) or 02 (elsewhere)

• Use modifier 93 for audio-only; no modifier needed for video

• Do not use CPT 98008–98015 (Medicare denies these)

Medicaid

Coverage varies by state:

• Many states adopt audio-only CPT codes

• Check specific Medicaid or MCO guidance.

 Private Insurers

Coverage depends on parity laws.

• Some states enforce full parity (equal reimbursement)

• Commercial payers may reimburse new CPT codes (98000–98016), while Medicare won't

Telehealth Reimbursement Rates & Parity

Reimbursement quotes rely upon payer and service:

• RPM/RTM costs 2025: 99453 ~$19.73; 99454 ~$43.03; 99457 ~$47.87; 99458 ~$38.49

• APCM G0556 ~$15.20

• Telehealth CPT vs. Office E/M: codes 98000–98004 reimburse lower than 99202–99205 (e.G., 98002 = $131 vs. 99204 = $163)

• Parity laws: some states require equal pay; others offer conditional parity

• Strategy: choose your code strategy based on payer policy

Telehealth Claims Submission Workflow

Patient Eligibility & Consent

• Verify patient coverage and modality

• Document consent for telehealth format and audio use if necessary

Appointment Documentation

• Record locations (provider, patient)

• Technology used (audio/video)

• Consent and reason for modality

Code & Modifier Selection

• Choose appropriate CPT/HCPCS code

• Add correct POS and modifier

• Ensure alignment with payer guidelines

Claim Submission

• Submit via EHR/clearinghouse

• Attach supporting documentation as needed

Denial Follow-Up

• Analyze rejection reasons

• Resubmit with corrections

• Track denial trends to improve workflows

Telehealth Billing Best Practices & Tips

1. Stay informed—replace on CMS, AMA, and payer adjustments

2. Train staff regularly on coding, documentation, and modality rules

3. Use checklists/software to flag missing information or mismatches

4. Check parity laws by state and payer; align billing accordingly

5. Audit claims monthly to reduce rejects and improve processes

Telehealth Billing Services & Outsourcing

Many practices use specialized telehealth billing services to handle:

• Claims management and submission

• Modifier and POS code expertise

• Appeals, denials, and compliance support

• Coding optimization for virtual care

Outsourcing can reduce errors and administrative load, especially if your team lacks telehealth billing experience.

Virtual Care Billing for Mental Health

Telehealth billing for mental health must pay attention to:

• CPT codes: 90791, 90832–90837, 90846–90847, G0444, G0459

• Use correct telehealth modifiers and POS

• Ensure privacy compliance (HIPAA)

• Confirm payer-specific documentation needs

• Use RPM/RTM/APCM where applicable (e.g., for depression or anxiety chronic care)
  
  

Diligent telemedicine billing and coding avoids denials and improves revenue management.

Telehealth Billing Services Comparison

Choose based on practice size, volume, and budget.

Conclusion

Mastering virtual medical billing is essential in 2025. Understanding telehealth billing codes, modifiers, CPT updates, place of service rules, reimbursement rates and high-quality practices permits vendors to publish smooth claims and prevent revenue leakage. Regular team of workers education and method audits are key. Whether in-house or outsourced, a strategic billing method can unlock the whole potential of your telehealth services

FAQ

Do I need a modifier for telehealth claims?

Yes. Use 95 or GT for audio-video and 93 for audio-only (Medicare requires it). POS should match the patient’s setting (10 or 02).

Can I bill RPM services remotely?

Absolutely. 2025 RPM codes—99453, 99454, 99457, and 99458—are payable monthly, provided device use is ≥16 days.

What about audio-only telehealth?

Use CPT 98008–98015 for commercial payers. Medicare allows office E/M codes (99202–99215) + modifier 93 under audio-only policy.

How do parity laws affect reimbursement?

Many states require payment parity (equal to in-office rates), but rules vary. Private payers may follow state laws or CMS pricing.

Is outsourcing telehealth billing worth it?

For busy practices, yes. Expert billing services reduce denials and ensure compliance—ideal for mental health or complex telehealth setups.