Did you know that a 2024 research study found that approximately 92.57% of telehealth patients from 2020 to 2022 are covered by Medicare, Medicaid, Medicare Managed Care, Blue Cross and Blue Shield (BCBS), and other commercial payers?
That’s not all; in-person visits covered by Medicare and Medicaid decreased by 15% from 2019 to 2022.
These numbers are enough to emphasize the rise of telehealth encounters, especially during and after COVID-19, and how streamlined telehealth billing can help you optimize your revenue cycle.
With that said, this guide covers a detailed list of telehealth CPT codes, common denial causes, and billing best practices. So, continue reading!
List of Telehealth CPT Codes 2026
This section breaks down the list of telehealth CPT codes. In addition, we have structured the codes into key service categories for better understanding.
So, here we go!
1. Dedicated Telehealth E/M Codes (AMA 98000 Series)
Telehealth CPT codes ranging from 98000 through 98015 are widely utilized by Medicaid plans and commercial insurance payers. However, Medicare does not recognize these codes (except 98016) and prefers providers to bill services via traditional 99202-99215 codes.
| Telehealth CPT Code | Description | Time Threshold |
|---|---|---|
| 98000 | Audio-video E/M visit for a new patient with straightforward medical decision-making. | 15 minutes or more. |
| 98001 | Audio-video E/M visit for a new patient with low-complexity medical decision-making. | 30 minutes or more. |
| 98002 | Audio-video E/M visit for a new patient with moderate-complexity medical decision-making. | 45 minutes or more. |
| 98003 | Audio-video E/M visit for a new patient with high-complexity medical decision-making. | 60 minutes or more. |
| 98004 | Audio-video E/M visit for an established patient with straightforward medical decision-making. | 10 minutes or more. |
| 98005 | Audio-video E/M visit for an established patient with low-complexity medical decision-making. | 20 minutes or more. |
| 98006 | Audio-video E/M visit for an established patient with moderate-complexity medical decision-making. | 30 minutes or more. |
| 98007 | Audio-video E/M visit for an established patient with high-complexity medical decision-making. | 40 minutes or more. |
| 98008 | Audio-only E/M visit for a new patient with straightforward medical decision-making. | 15 minutes or more. |
| 98009 | Audio-only E/M visit for a new patient with low-complexity medical decision-making. | 30 minutes or more. |
| 98010 | Audio-only E/M visit for a new patient with moderate-complexity medical decision-making. | 45 minutes or more. |
| 98011 | Audio-only E/M visit for a new patient with high-complexity medical decision-making. | 60 minutes or more |
| 98012 | Audio-only E/M visit for an established patient with straightforward medical decision-making. | 10 minutes or more. |
| 98013 | Audio-video E/M visit for an established patient with low-complexity medical decision-making. | 20 minutes or more. |
| 98014 | Audio-video E/M visit for an established patient with moderate-complexity medical decision-making. | 30 minutes or more. |
| 98015 | Audio-video E/M visit for an established patient with high-complexity medical decision-making. | 40 minutes or more. |
| 98016 | Brief synchronous virtual check-in (replaces HCPCS G2012). | 5 to 10 minutes. |
2. Traditional Office/Outpatient E/M Visit Codes
The table below lists the CPT codes for telehealth visits required by Medicare, with modifiers 95 or 93 and POS 10 or 02. Besides, these codes are accepted by many private insurance payers as well for telehealth encounters.
| Telehealth CPT Code | Description | Time Threshold |
|---|---|---|
| 99202 | New patient E/M visit with straightforward medical decision-making. | 15 minutes or more. |
| 99203 | New patient E/M visit with low-complexity medical decision-making. | 30 minutes or more. |
| 99204 | New patient E/M visit with moderate-complexity medical decision-making. | 45 minutes or more. |
| 99205 | New patient E/M visit with high-complexity medical decision-making. | 60 minutes or more. |
| 99211 | Established patient E/M visit that does not require the presence of a physician or other qualified healthcare professional. | N/A |
| 99212 | Established patient E/M visit with straightforward medical decision-making. | 10 minutes or more. |
| 99213 | Established patient E/M visit with low-complexity medical decision-making. | 20 minutes or more. |
| 99214 | Established E/M visit with moderate-complexity medical decision-making. | 30 minutes or more. |
| 99215 | Established E/M visit with high-complexity medical decision-making. | 40 minutes or more. |
3. Behavioral & Mental Health CPT Codes for Telehealth Visits
The following table offers an at-a-glance view of the main telehealth CPT codes for behavioral and mental health encounters. Note that these codes must be billed with appropriate telehealth modifiers and POS.
| Telehealth CPT Code | Description | Time Threshold |
|---|---|---|
| 90791 | It covers psychiatric diagnostic evaluation. | Up to 90 minutes. |
| 90792 | It includes psychiatric diagnostic evaluation with additional medical services. | 1 to 2 hours. |
| 90832 | It represents psychotherapy with the patient. | 16 to 37 minutes. |
| 90834 | It covers psychotherapy with the patient. | 38 to 52 minutes. |
| 90837 | It indicates psychotherapy with the patient. | 53 minutes or more. |
| 90846 | It represents family psychotherapy without the patient. | 26 minutes or more. |
| 90847 | It includes family psychotherapy with the patient present. | 26 minutes or more. |
| 90849 | Multiple-family group psychotherapy. | N/A. |
| 90853 | Group psychotherapy with a maximum of 12 patients. | 45 to 60 minutes. |
4. Virtual Check-Ins, E-Visits & Remote Monitoring
These CPT codes for telehealth enable providers to deliver asynchronous care and continuously track patient health metrics outside traditional office visits.
| Telehealth CPT Code | Description | Time Threshold |
|---|---|---|
| 99421 | Online digital E/M service with an established patient to discuss a health issue and possible treatment. | 5 to 10 minutes. |
| 99422 | Online digital E/M service with an established patient to discuss a health issue and possible treatment. | 11 to 20 minutes. |
| 99423 | Online digital E/M service with an established patient to discuss a health issue and possible treatment. | 21 or more minutes. |
| 99453 | Remote therapeutic/physiological monitoring setup and education. | N/A. |
| 99454 | It covers remote monitoring device supply with daily transmissions. | 16+ days of data per 30 days. |
| 99457 | It indicates remote monitoring clinical management services. | First 20 minutes. |
| 99458 | It is an add-on code that covers remote monitoring clinical management services. | Each additional 20 minutes. |
| G2010 | Remote evaluation of recorded video/images submitted by an established patient. | N/A. |
Common Reasons for Telehealth Claim Denials
The following are some of the key reasons that cause telehealth billing denials:
1. Incorrect POS Code
One primary reason for telehealth claim denial is the use of the wrong POS code.
Let’s review a scenario for better understanding!
Picture that you conducted the telehealth encounter when the patient was at his home. This accounts for the use of POS 10. However, you reported POS 02, which indicates the patient is not physically present at home. This misuse triggers denials and audit risks.
2. Modifier Misuse
Insurance carriers require you to append appropriate modifiers to telehealth CPT codes, such as 95, 93, and GT. Missing these or appending them to non-eligible procedural codes is another major reason behind claim denials.
3. Incomplete Documentation
What happens when you fail to document the mode of communication, total time spent, patient location, or patient consent? It results in claim denials.
4. Failure to Meet the Time Threshold Limit
You may also get denials when you bill timed telehealth CPT codes without recording exact start and end times.
Additionally, denials can occur when your documented time fails to meet the minimum cumulative time requirements set for the specific procedural code.
5. State Licensure & Out-of-State Care
Another denial cause can be billing for a patient who was physically located in a state where the rendering provider was not licensed or enrolled at the time of the service.
Best Practices to Minimize Telehealth Claim Denials
Now that you know the major reasons behind claim denials, it is time to understand the telehealth billing guidelines to ensure a healthier revenue cycle:
Front-End Verification & Authorization
You can prevent denials by implementing the following best practices in your front-end workflow:
- Run real-time eligibility (RTE) checks at scheduling.
- Perform RTE checks 24-48 hours before the visit.
- Validate active coverage, specific telehealth benefits, copays, and deductible status.
- Verify where the patient will be physically located during the encounter.
- Ensure that the rendering provider is licensed and credentialed in the state where the patient is attending the visit from.
- Utilize EHR automated alerts to track mandatory rolling in-person visit windows for Medicare tele-mental health and specific chronic care services.
- Flag high-complexity telehealth services, intensive behavioral health sessions, or specialized remote patient monitoring (RPM) programs for prior authorization before the visit occurs.
Clinical Documentation Standards
Implementing the following telehealth billing guidelines for documentation standards will help you steer clear of many denials:
- Configure EHR templates that enforce mandatory fields before a chart can be signed.
- Document whether the visit was synchronous audio-video or audio-only.
- When you conduct an audio-only visit, document the reason why audio-video was unavailable or clinically/technically unfeasible.
- Record both the physical location of the patient and the physical location of the provider.
- Explicitly record verbal or written patient consent for virtual treatment.
- Document exact start/stop times and total cumulative minutes spent for timed telehealth CPT codes.
Claim Scrubbing & Coding Accuracy
Discussed below are the key claim scrubbing and coding best practices to help you prevent telehealth claim denials:
- Configure your billing system to auto-map the correct POS code based on the patient’s physical location.
- Append appropriate modifiers. That is, use modifier 95 for synchronous audio-video services, modifier 93 for synchronous audio-only services.
- Do not forget to cross-check with private payers whether they accept modifier 93, 95, or GT, GQ.
- Leverage an automated claim scrubber programmed with custom rules for insurance payers.
- For example, scrub claims to ensure Medicare receives traditional E/M codes (99202–99215) with appropriate POS code and modifiers. Similarly, ensure private payer claims that accept the AMA 98000 series are routed appropriately.
Back-End Management & Continuous Auditing
Here are some of the back-end telehealth billing guidelines you can leverage to ensure a steady cash flow:
- Submit clean telehealth claims soon after chart sign-off (within 24 to 48 hours) to stay well within payer timely filing deadlines.
- Track remittance data using remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs). This will help you categorize denials by demographic errors, missing modifiers, incorrect POS, documentation errors, and medical necessity.
- Regularly conduct internal audits. That is, pull a sample of telehealth charts across providers to cross-check documentation against billed telehealth CPT codes, modifiers, and time logs. Based on the findings, provide direct feedback loops to clinicians when documentation falls short.
Bottom Line
To summarize, some of the major telehealth CPT codes include 98000-98016, 99202-99215, and G2010.
If you want to prevent denials while billing for these codes, you must ensure precise time-tracking, comprehensive documentation, appropriate use of POS code 02 and 10, and modifiers 93, 95, or GT, GQ.
Hopefully, with this guide as your go-to-resource, it will be easier for you to streamline your billing workflow. However, if you still struggle, feel free to outsource telehealth billing services to professionals at MediBillMD.
