In telehealth, practices may lose revenue from preventable billing mistakes, such as using the wrong modifiers, forgetting codes, and not following the latest payer policies. Poor telehealth billing is now costing the healthcare industry more than ever, as more and more outpatient visits are now virtual.
HS MED Solutions excel in the telehealth billing services sector to fill in those spaces. Our certified medical billing and revenue cycle management professionals have 25+ years of experience and will perform all aspects of claim scrubbing to denial appeals to ensure your practice receives what it is owed with every virtual visit.
What Are Telehealth Billing Services?
Telehealth billing services manage the complete revenue cycle for virtual patient visits. This includes selecting the correct CPT codes, applying required modifiers, verifying payer-specific coverage rules, submitting clean claims, and resolving any denials.
Unlike standard in-person billing, telehealth claims involve additional complexity: platform documentation requirements, originating site rules, place-of-service designations, and constantly shifting payer policies. A single billing error, like using POS 11 instead of POS 02, can trigger an automatic rejection and delay payment by weeks.
23%
Average revenue loss per practice from telehealth billing errors, most of which are preventable with proper modifier and code selection. (MGMA, 2024)
Why Telehealth Billing Is More Complex Than Standard Billing
Most providers assume telehealth billing mirrors in-person billing. It doesn’t. Here’s where claims consistently fail:
- Wrong or missing modifiers: Modifier 95 (synchronous telemedicine) or GT are required by most payers. Omitting it triggers automatic rejection.
- Incorrect place of service (POS) codes: POS 02 (telehealth) vs. POS 11 (office) directly affect reimbursement rates and claim validity.
- Originating site errors: Medicare has strict rules on where the patient must be located. Misapplying them is a top denial reason.
- Payer policy mismatch: Medicare, Medicaid, and commercial insurers each maintain different telehealth coverage rules, updated frequently.
- Incomplete documentation: Virtual visits must meet the same E/M documentation standards as in-person encounters, including medical decision-making (MDM) or total time.
- Prior authorization gaps: Some payers require pre-authorization for telehealth services that don’t need it for in-person equivalents.
Our medical billing specialists are trained on all of the above. Every claim is scrubbed for errors before it leaves our system.
CPT Codes Used in Telehealth Billing 2025 Reference
Choosing the correct CPT code for virtual visits is the foundation of clean telehealth billing. Below are the most commonly used codes, with key notes on documentation requirements. For the complete CMS telehealth code list, see the CMS Telehealth Services page.
| CPT Code | Description | Key Requirement |
| 99202–99205 | New patient office/outpatient E/M visits | Modifier 95 or GT required |
| 99212–99215 | Established patient E/M visits via virtual platform | MDM or total time documented |
| 99421–99423 | Online digital E/M services (patient-initiated) | 7-day time period per episode |
| 98966–98968 | Telephone assessment by non-physician providers | Not payable with same-day E/M |
| G2010 | Remote evaluation of recorded patient data | Patient-submitted video/image |
| G2012 | Brief communication technology-based visit | 5–10 minute medical discussion |
| G2061–G2063 | Qualified non-physician telehealth services | Technology-based check-ins |
| 99453–99454 | Remote physiologic monitoring (RPM) | 16+ days of data per 30 days |
Each code carries specific time thresholds, complexity levels, and documentation requirements. Our certified coders apply the right code every time, maximizing reimbursement while maintaining full compliance.
How HS MED Solutions Handles Telehealth Billing Step by Step
Insurance Verification & Prior Authorization
Before the virtual visit, we verify the patient’s telehealth benefits, confirm payer eligibility, and flag any prior authorization requirements. Catching coverage issues before the appointment prevents the most common source of denials.
Documentation Audit
We review provider notes to confirm they meet E/M documentation guidelines for virtual visits, including MDM criteria or total time, platform type, and patient location. Incomplete notes are flagged for provider review before coding begins.
Precise Code & Modifier Selection
Our AAPC-certified coders assign the correct CPT code and apply the appropriate modifier (95, GT, or GQ) based on each payer’s current policy. We also apply the correct POS code, POS 02 for telehealth or POS 10 for audio-only visits, to ensure proper reimbursement.
Claim Scrubbing & Submission
Every claim passes through our clearinghouse scrubbing process before submission, catching formatting errors, duplicate charges, and code conflicts. Claims go out within 24 hours of documentation receipt, our standard turnaround commitment.
ERA / EOB Posting & Reconciliation
We post all Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) payments, reconcile them against expected reimbursements, and flag underpayments for follow-up.
Denial Management & Appeals
Every denied claim receives a full analysis. Our denial management team identifies the root cause, corrects the issue, and submits a documented appeal — with supporting clinical documentation when needed. We track all appeals to resolution. Read more about our full revenue cycle management services.
Medicare & Medicaid Telehealth Billing Key Rules for 2025
Medicare expanded telehealth coverage significantly during the COVID-19 public health emergency, and many of those expansions have been extended through 2025 and beyond. According to the HHS Telehealth Billing Resource Center, key Medicare rules include:
- Patients may receive telehealth services from their home (POS 10) or other approved originating sites
- Services must be delivered via interactive, real-time audio-video technology (audio-only permitted for specific services)
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) bill telehealth under specific pathways
- Mental health telehealth now requires an in-person visit within 12 months of initiating or re-initiating care
Medicaid rules vary by state. Coverage, reimbursement rates, approved platforms, and originating site requirements differ significantly across state Medicaid programs. HS MED Solutions maintains current knowledge of state-specific Medicaid telehealth policies for all states where our clients practice.
Why Healthcare Providers Choose HS MED Solutions
25+ Years of Medical Billing Experience
We’ve navigated every major billing change since ICD-9, from ICD-10 transitions to COVID-era telehealth expansions to 2025 payer updates. That institutional knowledge directly reduces your denial rate.
AAPC-Certified Coders
Every coder on our team holds AAPC or AHIMA certification. Specialists handle telehealth billing because they understand the compliance requirements of virtual care, rather than generalists.
Proactive Denial Prevention
We don’t wait for denials to happen. Our claim scrubbing process identifies and corrects an average of 94% of errors before submission, reducing administrative costs and preventing revenue delays caused by appeals.
HIPAA-Compliant Operations
Every step of our billing workflow, from data transfer to claim storage to payment posting, operates under full HIPAA compliance protocols. Patient data is handled with bank-level security.
Transparent Reporting
You receive monthly reports on claim submission rates, denial reasons, collection rates, and revenue trends, with full visibility into your practice’s financial performance, no surprises.
Common Telehealth Billing Mistakes We Prevent
- Filing telehealth claims with an in-person place of service code (POS 11 instead of POS 02 or POS 10)
- Missing or wrong modifier causing automatic payer rejection
- Upcoding or undercoding E/M visits due to improper time documentation
- Billing telehealth services without verifying the payer’s coverage policy first
- Submitting claims past the payer’s timely filing deadline (most are 90–180 days from service date)
- Billing a telephone visit (audio-only) with the wrong CPT code for synchronous video visits
- Failing to document patient consent for telehealth, required by many states and payers
Stop Losing Revenue on Virtual Visits
Get a free telehealth billing audit. Our team will review your current claims, identify denial patterns, and show you exactly where revenue is being lost at no cost to your practice.
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