Telehealth Reimbursement Rates 2026: What Private Practices Actually Get Paid

Telehealth pays well in 2026 if you know the numbers and bill the claim right. It pays badly if you guess.

Most small practices leave money on the table every month because nobody told them what a telehealth visit should actually earn. They send out claims, see dollar amounts come back, and assume the payer knows best. The payer knows best for the payer. Your job is to know best for your practice.

This is a plain-English breakdown of what Medicare, Medicaid, and commercial plans pay for a telehealth visit in 2026, where parity laws help you, and the handful of moves that lift your average payment per encounter. No fluff, no vendor sales pitch disguised as advice. Numbers and rules you can hand to whoever runs your billing on Monday morning.

Medicare Telehealth Rates in 2026

Medicare is the easiest payer to pin down because it publishes a national fee schedule. For 2026, Medicare continues to pay telehealth E/M visits at the same rate as in-person visits when the service is on the covered telehealth list and billed with the right place of service. Here are the national non-facility rates most small practices see most often.

Two patterns to notice. Video and in-person pay the same at the national level for the common E/M codes. Audio-only pays less, which is why documenting the reason for a phone-only visit matters. The gap between 99213 and 99214 is roughly $42 per visit, which adds up fast when you see fifteen follow-ups a day.

Medicare also publishes locality adjusters. Rural and higher-cost metros can land 5 to 15 percent above or below the national figure. Pull your Medicare Administrative Contractor's current fee schedule for your specific locality. Most practices never bother and lose track of real revenue per visit.

Commercial Payer Rates: Variable and Usually Negotiable

Commercial plans are where things get messy and where there's real money to earn. National averages for commercial telehealth payments in 2026 look like this:

• 99213 telehealth: $95 to $140, depending on plan and state parity law.
• 99214 telehealth: $140 to $205.
• 99215 telehealth: $190 to $280.
• Audio-only (99441-99443): $0 to $120. A few national plans still refuse to pay for phone-only visits in 2026. Others pay at parity with video.
• Psychotherapy (90834, 90837): $110 to $200. Behavioral health has the widest spread because carve-out mental health networks price differently from the medical plan.

The spread between the floor and the ceiling in that list is the money most practices never collect. A 99214 paying $140 at one plan and $205 at another means the exact same encounter earns 46 percent more depending on which card is in the chart. Multiply that across a year of visits and the gap is not small.

Three things drive where you land in the range:

1. Your contract. Most small practices sign the standard fee schedule the payer offers at credentialing and never renegotiate. Payers raise rates for providers who ask. Ones who don't ask stay at the bottom of the range forever.
2. Your state's parity law. If your state has a payment parity statute, commercial plans must pay telehealth at the same rate as in-person for covered services. More on this below.
3. Your specialty mix and documentation quality. Plans adjust rates by specialty and by the complexity of a provider's typical claim. Higher-complexity practices get better fee schedules.

Medicaid: Fifty States, Fifty Fee Schedules

Medicaid is the hardest payer to generalize about because every state runs its own program. A 99213 for a Medicaid telehealth visit in California pays about $66. The same code in New Jersey pays about $43. In Alaska it pays close to $120. Treat Medicaid rates as a per-state research project, not a line on a spreadsheet.

A few patterns do hold up nationally in 2026:

• Most states now pay telehealth at parity with in-person. Roughly 40 states have a Medicaid payment parity rule for synchronous video visits. Audio-only parity exists in about half those states.
• Managed Medicaid plans use their own fee schedules. If your Medicaid patients are in a managed care plan (most are), look at the plan's provider manual, not the state's base fee schedule.
• Behavioral health has the strongest Medicaid coverage. Mental health and substance use disorder services are the services most consistently covered via telehealth across all state Medicaid programs.
• Prior authorization requirements have loosened but not disappeared. Some states still require prior auth for certain telehealth specialty visits. Check before you schedule.

Practical move: if Medicaid is more than 10 percent of your payer mix, assign one staff member to maintain a one-page cheat sheet of your top three Medicaid plans' telehealth rules. Covered codes, required modifiers, prior-auth triggers, and current rates. Update it twice a year. That document pays for itself in reduced denials.

Payment Parity Laws: Know Which Kind Applies to You

States have two different kinds of telehealth parity laws, and small practices confuse them all the time. The difference matters.

• Coverage parity requires commercial plans to cover telehealth services that would be covered in person. It says nothing about the rate. Nearly every state has coverage parity.
• Payment parity requires commercial plans to pay telehealth services at the same rate as in-person services. About half of states have some form of payment parity, and many of those parity statutes have exceptions and sunset clauses.

States with strong, in-force payment parity as of 2026 include California, New York, New Jersey, Washington, Georgia, Delaware, and about 20 others. States without payment parity leave the rate open to contract negotiation. Texas and Florida are two large non-parity states where telehealth rates vary widely between plans.

How to use this in your practice:

1. Look up your state's current rule. Search "[your state] telehealth payment parity statute" and read the actual law. The Center for Connected Health Policy maintains a free state-by-state tracker that's updated several times a year.
2. Check your commercial contracts against the law. If your state has payment parity and a payer's contracted rate for 99213 telehealth is lower than the in-person rate, that's a billable violation. Call the provider rep and ask for the correction.
3. Watch for exceptions. Some parity laws exclude audio-only, or carve out certain specialties, or sunset at the end of a public health emergency extension. Read the fine print.

Why Small Practices Underbill Telehealth

I've reviewed telehealth claims for dozens of small practices. The same leaks show up over and over.

• Down-coding out of caution. Providers who could legitimately bill 99214 bill 99213 because they're worried about audits. A 99213 bias costs a practice $40+ per visit, every day, forever. If the chart supports 99214, bill 99214.
• Billing audio-only when video was actually used. Phone-only visits pay less. If you did a video visit and the chart says "visit conducted via video," use the video codes and modifier 95, not 99441-99443.
• Not catching parity violations. Covered in the section above. Nobody reads their own contracts against the current state law.
• Writing off denials instead of appealing. First-pass denial rates for telehealth claims run around 10 percent. Practices that appeal recover around 60 percent of appealed amounts. Practices that don't appeal recover zero.
• Letting old contracts sit. A fee schedule signed in 2022 is almost certainly below current market in 2026. Payers renegotiate when asked, especially with practices that bring predictable volume.
• Mis-tagging the place of service. POS 11 for a patient at home is a common error. POS 10 is often paid at a higher rate than POS 02. The one-character difference can be 15 percent of a visit.

Pick one of these this month. Fix the leak. Then pick the next one. You don't need a billing consultant to do this work. You need a billing checklist and the discipline to run it.

How to Raise Your Average Payment Per Visit

Reimbursement is one half rate schedule and one half operational discipline. Here's the shortest checklist I've seen move the number for a small practice.

1. Pull your top five payers' current telehealth fee schedules. Just the five that make up most of your revenue. Compare them side by side against Medicare's national rate for the same codes. Anywhere a plan pays less than 100 percent of Medicare for 99213 or 99214, flag it as a renegotiation target.
2. Request a fee schedule review for your top three plans. Email your provider rep. Ask for the current rate, cite your visit volume and clean-claim rate, and ask what it would take to move to the next tier. You'll get a yes about half the time if you've been with the plan for more than two years.
3. Audit a random 20 claims per quarter. Pull 20 paid telehealth claims and verify each one hit the expected rate. Underpayments add up. Payers accidentally underpay, especially for new codes or modifier combinations. You can recover them if you catch them within the contract's claims window.
4. Code at the right level, not the safe level. Review your E/M distribution. If your 99213-to-99214 ratio is more than 70/30 for established patients, you're probably down-coding. The national benchmark for primary care is closer to 50/50.
5. Document time or MDM clearly in every note. Supports higher codes when they're justified. Protects you if a claim gets audited. Both benefits, same note.
6. Appeal every denial that has a legitimate reason to pay. Build a short appeal letter template. Add it to the workflow. Measure what you recover.
7. Verify telehealth benefits before every new-patient video visit. Prevents the biggest category of denial, which is "not a covered service for this plan at this location."

None of this is glamorous. All of it works. Practices that run this list consistently tend to see telehealth revenue per visit climb 10 to 20 percent in the first year compared to practices that don't.

Make Your Telehealth Platform Help You Get Paid

Your platform's job is to produce the information your billing team needs to code the claim correctly on the first try. Visit type (video, phone, SMS), patient location at the time of the visit, start and stop times, and the clinical note all have to flow out of the encounter in a form a biller can read without a decoder ring. If the system makes that hard, you'll underbill forever.

SimplyTelehealth records every visit as video, phone, or SMS, tags the patient's location, and timestamps start and end. That's the data billing needs to pick the right code, the right modifier, and the right place of service without hunting through chart notes. Combine the platform with the checklist above and the gap between what you earn and what you could earn narrows fast.

Reimbursement is not luck. It's rates, modifiers, documentation, and follow-through. Fix those four and your telehealth revenue stops being a mystery.