Not Every Visit Needs Video

Most telehealth platforms act like every visit is a video call. That's ridiculous. A two-minute med check doesn't need a camera. A post-op follow-up where you're asking "any redness?" works fine over the phone. And a simple "refill approved, continue current dose" is a plain text message.

But when video is your only option, every visit turns into a production. Send a link, check the browser, open a waiting room, toggle the camera, and wait for at least one patient to say "can you hear me now?" Meanwhile, you've burned five minutes on setup for a visit that should've taken three.

It gets worse. Rural patients don't have the bandwidth. Older patients don't have a webcam. Some patients with disabilities find video calls exhausting. When video is the only door, those patients either skip the visit entirely or drive to your office for something that could've been a phone call.

Offering video, phone, and text visits isn't a nice-to-have. It reduces no-shows, improves access, and makes your day run smoother.

Video Visits: When and Why

Video is the right tool when you actually need to see the patient. It's the closest thing to an in-person encounter, and for certain visit types, nothing else comes close.

Best for

What it requires

Both sides need decent internet, a camera, and a reasonably quiet space. That's a higher bar than it sounds. Patients in rural areas, patients borrowing a family member's phone, patients sitting in a parking lot on their lunch break. Video doesn't work great for any of them.

Billing

Video visits use standard telehealth E/M codes (99202-99215 with modifier 95 or place of service 10). Most payers cover these at parity with in-person visits, though policies vary by state and plan. This is the most straightforward billing path you'll find in telehealth.

Phone Visits: The Most Underrated Option

Phone visits don't get enough respect. Providers skip right past them, but patients love them. They're easy, they're familiar, and they work on literally any phone.

Best for

How it works

With a proper telehealth platform, phone visits use a conference dial-in with unique PINs for each appointment. The patient calls a number, enters their PIN, and the provider joins from the platform. Nobody uses a personal cell number. The call is logged with start and end times for your records.

This is not the same as calling patients from your cell phone. A structured system gives you documentation, HIPAA compliance, and a clear wall between work and personal life. That matters.

Billing

Telephone E/M codes are 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). They're time-based, so document your start and end times. Reimbursement varies by payer, but many commercial plans cover them, and Medicare has expanded telephone visit coverage significantly.

The patient preference factor

Here's something that catches providers off guard: a lot of patients actually prefer the phone. They don't want to worry about how they look on camera. They don't want to find a quiet room. They don't want to troubleshoot tech. They want to talk to their doctor, and a phone call does that perfectly well.

SMS Text Visits: When and Why

Text visits fill a gap that's existed in telehealth for years. There's a whole category of patient interaction that's more than a portal message but less than a full real-time call. SMS visits are built for exactly that.

Best for

How it works

SMS visits are asynchronous. The platform opens a secure text thread between provider and patient using a private relay number. Neither party sees the other's personal phone number. The patient sends their message or photo, you review and respond when you're ready, and the conversation continues until the clinical question is handled. The platform tracks cumulative time for billing.

This is completely different from texting patients on your personal phone. The relay number protects both sides, the messages are encrypted and logged, and you've got a clear record of the encounter. No gray areas.

Billing

E-visit codes 99421 (5-10 minutes cumulative), 99422 (11-20 minutes), and 99423 (21+ minutes) apply to digital communications with established patients. Time is measured cumulatively over up to seven days, so you don't need to handle everything in one sitting. Document total time spent reviewing and responding.

The sweet spot

SMS visits live in valuable middle ground. They're more billable and structured than a portal message, but way less disruptive than a synchronous call. If your practice handles a high volume of routine follow-ups, text visits can seriously improve throughput without cutting corners on care.

Side-by-Side Comparison

Video Phone SMS Text
Best for Initial consults, therapy, visual exams Quick check-ins, elderly patients, rural areas Follow-ups, med checks, younger patients
Synchronous? Yes, real-time Yes, real-time No, async
Patient needs Internet, camera, quiet room Any phone Any phone with texting
CPT codes 99202-99215 (modifier 95) 99441-99443 99421-99423
Time basis Medical decision making or time Total call time Cumulative over 7 days
Privacy Encrypted video link Conference PIN, no personal numbers Relay number, no personal numbers
No-show risk Moderate (tech issues) Low Very low (async)
Accessibility Requires broadband Works on any phone, any connection Works on any phone with cell service

Matching Medium to Patient

You don't need a complicated algorithm for this. A simple decision tree covers most cases.

Quick Decision Guide

  • New patient? → Start with video. You need a visual baseline and rapport.
  • Established patient, routine follow-up? → SMS text visit. Quick, async, and efficient for both sides.
  • Patient over 70 or limited internet? → Phone visit. Low barrier, high comfort.
  • Therapy or behavioral health? → Video. Non-verbal cues matter.
  • Medication check with established patient? → SMS or phone. Either works.
  • Need to see a wound, rash, or physical finding? → Video, or SMS if the patient can send a photo.

Even better: let patients choose. When you set up self-scheduling, give them the option to pick video, phone, or text. You'll be surprised how many pick phone or SMS when given the choice. That's not a downgrade in care. It's meeting patients where they are.

A solid default for most practices: video for new patients and complex visits, phone or SMS for everything else. Adjust from there based on your specialty and patient population.

Why Most Platforms Only Offer Video (and Why That's a Problem)

Most telehealth platforms were built during the mad rush to virtual care. Video was the obvious first feature. It makes the best demo. It looks the most like an in-person visit. And for a while, video-only was fine.

But if you've been doing telehealth for more than a year, you already know: video is necessary but not sufficient. A platform that only does video forces every patient interaction into the same format, whether it fits the clinical situation or not. That's lazy design, and your practice pays the price.

Phone and SMS aren't lesser alternatives. They're different tools for different jobs. A practice that offers all three can handle a wider range of encounters, reach more patients, and cut the friction that causes no-shows and cancellations.

When you're shopping for a telehealth platform, ask if it supports all three visit types from one interface. Juggling one system for video, another for phone, and cobbling together SMS on your personal device is a compliance risk and an operational headache. You want one schedule, one place to document, and consistent billing support across every visit type.

Offer Your Patients Video, Phone, and SMS Visits

All from one platform. One schedule, one interface, one place to manage every visit type your practice needs.

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