Telehealth Billing in 2026: CPT Codes, Modifiers, and Medicare Rules

Telehealth visits pay. The trick is billing them so the claim actually comes back paid instead of denied, underpaid, or stuck in limbo for six weeks.

This is the guide I wish someone had handed me the first time we had to clean up a pile of rejected telehealth claims. No theory, no 80-page CMS document summaries, just the codes, modifiers, and rules small practices actually need for 2026. Federal telehealth flexibilities shifted again this year, and a few habits that worked in 2024 will get you denied today.

Bookmark this. Hand it to whoever does your billing. Then fix the leaks.

The Core Codes You'll Use Most

Telehealth billing doesn't use a special set of visit codes. You bill the same evaluation and management (E/M) codes you'd use in person, then tell the payer it was virtual with a modifier and a place of service code. Here are the codes small practices run into most.

Two things to notice. First, the 992xx office visit codes cover the majority of telehealth visits, because a virtual visit is still an E/M encounter. Second, Medicare tracks audio-only and SMS-style visits with their own code families. Using 99213 for a phone call is a common mistake that gets claims denied.

Modifiers That Decide Whether You Get Paid

Modifiers are the two-character tags that tell a payer what kind of visit you ran. Skip one, use the wrong one, and the claim either denies or pays at a lower rate. These are the ones that matter for telehealth.

• Modifier 95 signals a synchronous audio and video telehealth visit. Use it on most commercial claims for real-time video visits.
• Modifier 93 signals an audio-only synchronous telehealth visit. Use it on phone dial-in visits when the patient couldn't or didn't want to use video.
• Modifier GT used to mean "via interactive audio and video." CMS retired it for Medicare years ago, but some commercial payers still require it. Check each payer's policy.
• Modifier GQ signals asynchronous store-and-forward telehealth. Rare outside specific federal demonstration projects.
• Modifier FQ signals an audio-only behavioral health service. Required on many mental health phone visits in 2026.
• Modifier FR signals the provider was present by real-time audio and video, used in teaching-physician and supervisory scenarios.

Place of Service Codes for Telehealth

Place of Service (POS) tells the payer where the service happened. Telehealth has two codes that matter.

• POS 10 means the patient was at home during the visit. Use this for almost every virtual visit a small practice runs. Commercial payers typically pay POS 10 at the full in-office rate.
• POS 02 means the patient was somewhere other than home, usually another facility. Pay rates are often lower than POS 10 because the assumption is that originating-site costs are covered elsewhere.

Choosing the wrong POS is one of the top denial reasons in telehealth claims audits. If the patient was sitting on their couch, it's POS 10. Not 11 (office), not 02. This small distinction routinely costs practices 15 to 25 percent of a visit's reimbursement.

Medicare Telehealth Rules in 2026

Medicare is where most of the year-to-year rule changes happen, and 2026 is no exception. Here's what's true right now.

• Home is still the originating site. Patients can receive Medicare telehealth visits from home. Geographic and site restrictions that applied pre-pandemic remain waived for the common E/M and behavioral health codes.
• Audio-only is still covered for most E/M. Medicare continues to pay for audio-only evaluations using the 99441-99443 family when video isn't feasible. Document why video wasn't used. A note like "patient declined video, audio-only visit conducted" is enough.
• Behavioral health keeps the biggest permanent coverage. Mental health and substance use disorder telehealth services, including audio-only, are now permanently billable to Medicare from the patient's home. An in-person visit within six months before the first telehealth session is still required for some behavioral health services unless the clinical situation makes it impractical.
• Direct supervision via telehealth is allowed. Supervising providers can be "immediately available" through real-time audio and video for incident-to billing. Useful for practices with advanced practice providers.
• Licensure is on the provider, not CMS. Medicare's rules don't override state licensure. The provider still has to be licensed in the state where the patient is physically located at the time of the visit.

Rules after 2025 have been extended in phases by Congress and CMS. Check the current CMS telehealth list each January before you assume a code is still covered, and confirm your specific MAC's (Medicare Administrative Contractor) guidance.

Commercial Payers and Medicaid

Commercial plans mostly follow Medicare, but they don't have to. You'll see real variation between BCBS plans, UnitedHealthcare, Aetna, Cigna, and regional payers.

• Payment parity is a patchwork. Some states mandate that commercial plans pay telehealth at the same rate as in-person visits. Others don't. A few require parity only for certain service categories. Look up your state's parity law before you assume equal pay.
• Modifier requirements differ. Most plans accept modifier 95. A handful still want GT. Some want both. Others want neither if POS 10 is on the claim. Build a cheat sheet per payer and keep it with your billing workflow.
• Audio-only coverage varies. Commercial plans have trimmed phone-only coverage faster than Medicare. Check each plan's current policy before you bill 99441-99443 or 99213 with modifier 93.
• Medicaid is state by state. Every state's Medicaid program has its own telehealth rules, covered code list, and required modifiers. Your state's Medicaid provider manual is the source of truth.

If that sounds like a pain, it is. The practical fix is to test one claim per payer per visit type when you onboard a new plan, confirm payment, and then template that format for every claim that follows.

Five Billing Mistakes That Cost Practices Money

These show up in almost every denial audit I've looked at. Fix these first and your clean-claim rate jumps.

1. Using POS 11 instead of POS 10. POS 11 is the in-office code. Putting it on a telehealth claim will either deny or underpay every time. Patient at home, POS 10.
2. Forgetting the modifier. A 99213 without a 95 or 93 looks like an in-person visit to the payer. Worst case, fraud. Best case, denial.
3. Billing a phone call as 99213. If there was no video, it's 99441-99443 or 99213 with modifier 93, depending on payer. A bare 99213 on an audio-only encounter gets flagged.
4. Missing documentation for audio-only. If you're billing a phone visit, the chart note has to say so. Include the reason video wasn't used (patient preference, technical limitation) and the total time spent.
5. Not verifying telehealth benefits before the visit. Run a benefits check the same way you would for in-person. Some plans carve telehealth into a different network or require prior auth for certain specialties.

A Simple Billing Workflow That Works

You don't need a coder on staff to get telehealth billing right. You need a short, repeatable checklist everyone in your practice follows.

1. Verify benefits before the visit. Confirm telehealth is covered, any prior-auth requirements, and the patient's copay. This prevents half your downstream problems.
2. Pick the visit type on purpose. Video, phone, or secure messaging. Document which one you used. The visit type drives the code and modifier.
3. Note the patient's location. Home equals POS 10. Somewhere else is POS 02. One line in the chart note is enough.
4. Bill the right E/M family. 99212-99215 for established patients on video, 99441-99443 for audio-only, 99421-99423 for asynchronous messaging, 90834/90837 for psychotherapy.
5. Attach the right modifier. 95 for video, 93 for audio-only, FQ for behavioral health audio-only. Add GT only when a specific payer requires it.
6. Document time and medical decision making. Same rules as in-person. Total time or MDM level supports your code choice.
7. Track denials by reason code. If you see the same denial three times in a month, fix the root cause once and the problem goes away.

Practices that run this list consistently end up with clean-claim rates above 95 percent on telehealth. The ones that improvise, don't.

The right telehealth platform makes this easier by surfacing the visit type and patient location in the encounter record, so the billing team isn't piecing information back together from memory. SimplyTelehealth tags every visit as video, phone, or SMS and records patient location at the time of the visit, which cuts down the coding mistakes that cause the most denials. Pair that with the workflow above and your telehealth revenue becomes predictable instead of an adventure.