Get Paid for Every
Virtual Visit
Telehealth billing is one of the most technically complex areas in medical billing — requiring precise modifier selection (95, GT, FQ, FR), correct Place of Service codes (02 vs 10), and payer-by-payer coverage knowledge that changes every quarter.
Healix RCM specializes in telehealth claim submission across all 20+ medical specialties — from psychiatry and behavioral health to cardiology and internal medicine — ensuring every virtual visit generates the revenue it deserves.
Why Telehealth Billing Requires Specialized Expertise
Standard medical billing workflows were built for in-office encounters. Telehealth introduces an entirely new layer of coding rules — modifiers, POS codes, payer-specific policies, and cross-state compliance requirements — that generic billing teams consistently get wrong. Each error translates directly into delayed or denied revenue.
Modifier Selection Complexity
Telehealth claims require one of four modifiers — 95 (synchronous A/V), GT (Medicare interactive), FQ (audio-only), or FR (remote supervision). Applying the wrong modifier, or omitting it entirely, triggers an automatic denial. Rules change by payer and by year, making manual modifier selection error-prone at scale.
POS Code Confusion
The Centers for Medicare & Medicaid Services added POS 10 (telehealth — patient at home) in 2022 alongside the existing POS 02 (telehealth — other location). Many billers still default to POS 02 for all telehealth visits, causing reimbursement at the wrong rate and triggering payer audits. The correct POS code directly affects your allowed amount.
Payer Policy Fragmentation
Commercial insurers each maintain separate telehealth policies — Aetna, BlueCross, United, Cigna, and Humana all differ on which services qualify, which modifiers they accept, whether audio-only is covered, and what prior authorization is required. A claim that pays cleanly with Medicare may deny outright with a commercial payer using identical coding.
Telehealth CPT Codes & Modifier Reference
Telehealth claims use standard E&M codes (99202–99215) plus telehealth-specific G-codes and digital E&M codes. The modifier applied — and the place of service — determine how much each claim pays. Our billing team applies the right code combinations for every payer.
| CPT Code | Description | Required Modifier | Medicare Rate |
|---|---|---|---|
| 99202 | New patient office/outpatient — low complexity | 95 or GT | ~$78 |
| 99203 | New patient office/outpatient — moderate complexity | 95 or GT | ~$121 |
| 99204 | New patient office/outpatient — mod-high complexity | 95 or GT | ~$175 |
| 99205 | New patient office/outpatient — high complexity | 95 or GT | ~$218 |
| 99212 | Established patient — low complexity | 95 or GT | ~$58 |
| 99213 | Established patient — moderate complexity | 95 or GT | ~$98 |
| 99214 | Established patient — mod-high complexity | 95 or GT | ~$148 |
| 99215 | Established patient — high complexity | 95 or GT | ~$201 |
| 99421 | Online digital E&M — 5 to 10 minutes | None | ~$15 |
| 99422 | Online digital E&M — 11 to 20 minutes | None | ~$29 |
| 99423 | Online digital E&M — 21+ minutes | None | ~$47 |
| G2012 | Brief virtual check-in — 5 to 10 minutes | FQ (audio-only) | ~$14 |
| G2010 | Remote evaluation of pre-recorded images/video | None | ~$12 |
| 98970 | Qualified nonphysician telehealth — 5 to 10 minutes | 95 or GT | ~$26 |
Rates shown are approximate Medicare national average allowable amounts. Actual payments vary by locality, payer, and contract.
Place of Service Codes: POS 02 vs POS 10
The Place of Service code directly determines your reimbursement rate. POS 10 (patient at home) pays at the non-facility rate — which is meaningfully higher for E&M codes than POS 02 (facility rate). Using the wrong POS code is one of the most common and costly telehealth billing mistakes.
Telehealth — Other Location
Used when the patient connects from a location other than their home — such as a skilled nursing facility, a Federally Qualified Health Center (FQHC), or a rural originating site. POS 02 typically reimburses at the facility rate, which is lower than the non-facility rate.
Telehealth — Patient at Home
Added in 2022 to reflect the COVID-era expansion of home-based telehealth. POS 10 reimburses at the non-facility (office) rate — making it the higher-paying option for most E&M codes. Billing POS 02 when the patient is at home systematically underpays your practice.
What Our Telehealth Billing Service Includes
Our full-service medical billing team handles every step of your telehealth revenue cycle — from visit documentation review to final payment posting.
Modifier Selection & Validation
We determine the correct modifier — 95, GT, FQ, or FR — based on the session type, platform, payer, and visit documentation. Every claim is validated before submission.
POS Code Determination
Our team assigns POS 02 or POS 10 based on the patient's location at time of service, maximizing your reimbursement rate on every virtual visit.
Audio-Only Billing (FQ)
We capture revenue from telephone-only visits using the FQ modifier and G2012 code, ensuring compliant audio-only claims pass payer edits that reject improperly coded telephone visits.
Cross-State Licensure Billing
We verify provider state licensure against patient location before claim submission, preventing denials from cross-state practice violations — a frequent source of telehealth claim rejections.
Payer-Specific Policy Compliance
We maintain up-to-date telehealth coverage matrices for Medicare, Medicaid (by state), and all major commercial payers — applying the correct rules per visit, per payer, per plan.
Telehealth Denial Management
We rework telehealth denials with targeted appeals — correcting modifier errors, adding missing documentation, and resubmitting with appropriate supporting records to recover revenue.
Digital E&M Capture (99421–99423)
Most practices completely miss asynchronous online E&M codes. We identify and bill eligible portal/messaging encounters for additional revenue that requires no extra clinical work.
ERA & Payment Reconciliation
We post and reconcile all telehealth remittances — catching underpayments, incorrect rate applications, and bundling errors that often affect virtual visits differently than in-office claims.
Telehealth Coverage by Payer
There is no universal telehealth billing standard. Each payer maintains its own policy for covered services, accepted modifiers, prior authorization requirements, and audio-only coverage. Healix RCM maintains a live payer policy database updated quarterly.
| Payer | Telehealth | Audio-Only | Modifier | POS | Notes |
|---|---|---|---|---|---|
| Medicare | 95 or GT | 02 or 10 | Most telehealth categories extended post-2024 | ||
| Medicare Advantage | 95 or GT | 02 or 10 | Varies by plan — check individual coverage | ||
| Medicaid | Varies | Varies | State-by-state — 49 states cover some telehealth | ||
| Aetna | 95 | 02 or 10 | Pre-auth required for behavioral health | ||
| BlueCross | GT or 95 | 02 or 10 | Plan-level variation; check BCBS local plan | ||
| UnitedHealthcare | 95 | 02 or 10 | Some services require prior authorization | ||
| Cigna | 95 | 02 or 10 | Broad telehealth coverage across product lines | ||
| Humana | GT | 02 | MA plans vary; GT required for Medicare |
Our Telehealth Billing Process
Every telehealth encounter goes through a structured seven-step workflow designed to maximize clean claim submission rates and minimize the time between visit and payment. This is part of our broader revenue cycle management approach.
Visit Documentation Review
We review each telehealth encounter note to confirm the visit type (synchronous, audio-only, asynchronous), platform compliance, and medical decision-making documentation before coding begins.
CPT Code & Level Selection
We assign the correct E&M or telehealth-specific CPT code based on the 2021 AMA E/M guidelines. Level selection is validated against total time or MDM complexity documented in the note.
Modifier & POS Assignment
Our modifier engine applies 95, GT, FQ, or FR — and sets POS 02 or POS 10 — based on the session type, patient location, payer, and service category. This is the highest-error step in telehealth billing.
Payer Policy Compliance Check
Every claim is validated against that payer's current telehealth coverage policy before submission — catching services that require prior authorization or are excluded from virtual coverage.
Clean Claim Submission
We submit electronically via 837P transaction with all modifiers, diagnosis codes, rendering provider NPI, and telehealth-specific data elements correctly populated for first-pass acceptance.
ERA Posting & Reconciliation
We post remittances immediately and flag any telehealth-specific underpayments — including incorrect rate application (facility vs non-facility) or improper POS downcoding by the payer.
Denial Resolution & Appeals
Denied telehealth claims are worked within 48 hours. We identify the specific denial reason, correct the coding or documentation, and resubmit with a targeted appeal letter when required.
Why Telehealth Claims Get Denied — and How We Fix Them
Telehealth denial rates are 2–3× higher than in-office claim denial rates across the industry. Our claims processing team knows the specific denial triggers and resolves them before submission — not after.
Telehealth Revenue Your Practice Is Missing Right Now
Most telehealth-enabled practices capture only 60–70% of their billable virtual revenue. The gap comes from four predictable sources — all of which Healix RCM systematically closes.
Audio-Only Visit Revenue
Telephone-only visits qualify for reimbursement under G2012 and audio-only E&M codes with the FQ modifier — but most practices either don't bill them or bill them incorrectly and absorb the denial. If your practice sees 50 audio-only visits per month, that's $700+ in recoverable monthly revenue most practices are leaving behind.
Online Digital E&M (99421–99423)
Patient portal messages, emails, and text-based consultations that take 5 or more minutes of provider time qualify for asynchronous digital E&M codes. This is revenue generated from clinical work your providers are already doing — without any additional appointments. Nearly all practices that offer portal access leave this revenue uncaptured.
E&M Level Under-Coding
Telehealth practices consistently under-code E&M visit levels due to documentation anxiety — billing 99213 when the MDM and total time clearly support 99214 or 99215. The difference between a 99213 and 99215 is $103 per visit. At 20 visits per day, that's a potential $2,000+ daily revenue gap from under-coding alone.
POS 02 vs POS 10 Rate Differential
Billing POS 02 (facility rate) when the patient is at home (should be POS 10, non-facility rate) causes systematic underpayment. The non-facility rate for 99214 is approximately $148 vs $115 at the facility rate — a $33 gap per visit. For a practice with 30 telehealth visits per day, incorrect POS coding costs nearly $1,000 daily in unrealized revenue.
Find Out Exactly How Much Telehealth Revenue You Are Missing
Our free telehealth billing audit identifies every coding gap, missed code, and under-payment across your last 90 days of virtual visits.
Request Your Free AuditTelehealth Billing — Frequently Asked Questions
Our billing specialists answer the most common questions from providers navigating virtual visit billing for the first time — and from practices that have been billing telehealth and still leaving money behind.
What CPT codes are used for telehealth visits?+
What is the difference between Modifier 95 and Modifier GT?+
When should I use POS 02 vs POS 10 for telehealth?+
Are audio-only telehealth visits covered by insurance?+
Does Medicare cover telehealth services?+
What if my patient is in a different state than my practice?+
Reviewed & Verified By
Healix RCM Telehealth Billing Team — CPC & CPMA Certified
This page was reviewed by our Certified Professional Coders (CPC) and Certified Professional Medical Auditors (CPMA) with specialized expertise in telehealth billing, modifier compliance, and payer-specific telehealth policy. Our team has billed telehealth encounters across 20+ medical specialties for 500+ practices nationwide. All billing practices referenced reflect current CMS guidelines and commercial payer policies as of 2024–2025. Healix RCM is fully HIPAA-compliant and holds active BAAs with all partner platforms.
Stop Losing Revenue on Every Virtual Visit
Our telehealth billing specialists are ready to audit your current virtual visit claims, identify modifier and POS coding gaps, and implement a billing workflow that captures every dollar your telehealth practice earns. Contact our team today for a no-obligation telehealth revenue review.