Telehealth Billing Services by Certified Coders
Telehealth visits are not office visits with cameras attached, and billing them as such is how clean claims become denials. UControl classifies telehealth claims based on the regulations that apply for this year, this payer, and the state in which the patient was located. We combine 50-state revenue cycle management with our expertise in the latest CMS and commercial payer regulations to ensure that an audio-video synchronous visit shows up as a telehealth visit and reimburses at the rate earned. The outcome: telehealth denials are minimized, and your virtual care revenue stream is predictable.
Enter Your Details
Pinpoint What Is Costing You On Every Telehealth Claim
We pull a recent batch of your telehealth claims and show you which coding or rule mismatch is costing you, at no charge.
- Our telehealth claims get denied for the wrong place-of-service code
- We are unsure which modifier each payer wants, 95 or 93, GT or FQ
- We bill virtual visits across several states and lose track of each one's rules
- We cannot keep pace with the Medicare telehealth changes and extensions
- Claims are getting paid as in-person, or rejected as ineligible for telehealth
This is why telehealth billing cannot simply be switched on or off. Its coding rules are payer-dependent; the list changes each January; and federal flexibilities have expiration dates too. We bill according to this dynamic scene as your revenue cycle management team, not as vendors plugging telehealth into an office-based procedure template.
What Is Telehealth Billing?
Telehealth billing is the process of coding and filing the claim for the healthcare services provided through real-time audiovisual and phone communications rather than face-to-face visits. The service itself may be same, however, the claim would differ from it significantly as the payers will need some sort of identifier for recognizing the virtual nature of the encounter which comes in the form of the modifiers and place of service codes.
What Makes It Different From In-Person Billing
There are only two coding components which make the difference between telehealth and traditional in-person visit billing – a modifier that identifies whether the encounter was done via synchronous audio-video or audio alone; and place of service code identifying the location of the patient – at home or in the facility.
Below these lies a third trap. Not all procedures can be billed via telehealth because CMS maintains its own list of telehealth eligible codes. Submitting an ineligible code for telehealth results in denial even before the payer makes any decision because the denial was created by the practice itself.
What Turns A Payable Virtual Visit Into A Denial?
Telehealth denials almost never happen due to the treatment itself. It’s always due to selecting a code that is incompatible with the payer’s telehealth guidelines, and almost every one of them is preventable prior to submission. Here are the types we see most frequently, and what we close at intake.
Incorrect place-of-service code – Using POS 02 when the patient is home, or assuming that POS 11 should be used by an office-based provider performing a video visit, will result in a denial, even with the modifier being correct.
Incompatible modifier – Using modifier 95 where a commercial payer needs it and the visit is considered in-person. Coding a visit using audio-only when it is a video visit, thus making the modality incorrect relative to documentation.
Unacceptable code billed virtually – Coding a procedure that is not listed by CMS for virtual delivery as a telehealth service will lead to a self-inflicted denial, since this code was never reimbursable in that modality.
Payer rule mismatch – While one claim passes through Medicare, it fails at a commercial plan because of a need for a different modifier, or because a commercial payer does or doesn’t accept new telemedicine codes.
Each of these is a coding decision, which means each is fixable upstream. We scrub the modality, the location, the code eligibility, and the payer’s specific rule before the claim leaves, so the denial never posts.
Modifiers, Place-of-service, And The Codes Payers Scrutinize
The majority of the billers do not go past modifier 95 and consider the others as details. Detail is where the decision for payment or denial takes place for telehealth claims. We do everything in full coding layer according to payer’s interpretation.
Modifier 95 versus 93
We use modifier 95 for synchronous audio-video on an eligible code, and 93 for real-time audio-only on a code, where documentation will prove the reason for not using video.
GT, FQ, and GQ when applicable
We use GT on those institutional claims that require it, FQ on audio-only in FQHC and RHCs, and GQ on store-and-forward in those limited programs where it is recognized.
POS 10 versus 02
We use POS 10 when the patient’s site is their home, which usually gets paid as non-facility. POS 02 is where the patient is in the clinic/facility, hence the location does not contradict our claim.
Eligible Code list and 98000 series
We verify every code against the current CMS telehealth list, and we are aware that Medicare denies new 98000 series codes while some commercial payers allow them.
| Visit scenario | Modifier | Place of service |
|---|---|---|
| Audio-video, patient at home | 95 for commercial; POS-driven for Medicare | POS 10 |
| Audio-video, patient at a facility | 95 for commercial | POS 02 |
| Audio-only, video declined or unavailable | 93, or FQ at an FQHC or RHC | POS 10 or 02 by location |
| Store-and-forward, limited programs | GQ | Per program rule |
Medicare and commercial payers do not read these the same way. Medicare leans on the place-of-service code for audiovisual visits, while most commercial plans require the modifier, and knowing which payer wants which is the difference between payment and a rework cycle.
Current expiration for most Medicare telehealth flexibilities, including home as an originating site for non-behavioral care, under the Consolidated Appropriations Act 2026.
Billing Inside Rules Change Every Year – What's New In 2026?
Coverage for telehealth has existed under temporary extensions past the end of the PHE, and dates keep changing. You cannot operate a practice and keep a federal calendar at the same time. So, we keep track of it because your claims need to be covered by whatever extension is active at that time.
As of the Consolidated Appropriations Act signed into law in February 2026, almost all of the Medicare flexibilities expire on December 31, 2027. This means that the patient’s place of residence will be recognized as an originating site for non-behavioral care until December 31, 2027.
This is highly fragile, and it has already caused some losses for practices. Flexibilities expired during the late-2025 government shutdown, and CMS directed contractors to process such claims after the shutdown was resolved. Our billing partner that kept an eye out for such expiration did not write off these claims.
CMS and Consolidated Appropriations Act 2026, signed February 3, 2026. Re-verify before relying on the date.
Telehealth Billing For Multi-state And Virtual-first Practices
When the billing is based on virtual-first billing in the location of the patient and not in the provider’s office, the number of rules becomes magnified. Any particular state from which the practice generates claims will generate its own policy for the practice’s Medicaid patients, its own requirement for licensure, and its own need for the practice to be enrolled with payers.
It is the kind of problem that does not scale easily internally, because 50-state coverage makes all the difference here. Each claim must be matched against the practice’s licensure and payer enrollment for that specific state, while each state’s Medicaid program has its own telehealth policies instead of relying on those of Medicare.
The introduction of the new codes for telemedicine services also complicates things. For instance, a commercial payer in one state might accept the 98000 series of codes, but reject them elsewhere. This is the information that the practice does not have to store in a spreadsheet.
The documentation that holds a telehealth claim up
Telehealth claims can withstand payer audits only if they have a proper record behind them. Since telehealth is by definition a suspicious thing for auditors, a clean claim without any evidence behind it is a denial or recovery waiting to happen, so we always ensure that the record is consistent with the billing code before submission.
Consent
A patient’s agreement with a telehealth visit should be documented in the record, as there are several payers who require this documentation to cover the service provided.
Modality and reason
The note should document what kind of connection a patient used during his visit – audio-video or audio-only, and in the case of audio-only, the reason why he could not use video connection.
Patient location
Location of a patient needs to be documented in a record, because place-of-service code documents his exact location.
Platform and time
The platform used for telemedicine and time spent during a session should be documented, if time is a criterion for choosing a code.
Since we review documentation prior to submission of a claim, we make sure that the two do not contradict one another. Such review is the best protection from retrospective audits of visits made weeks ago.
What Our Telehealth Billing Service Covers
Telehealth coding and billing is but one part of the revenue cycle, and we optimize everything according to it. The RCM process that codes the visit verifies eligibility prior and pursues the claim afterward without any breaks or gaps between vendors.
Eligibility and consent validation
We check the insurance eligibility prior to the visit and verify that the documentation includes the consent, modality, location, and platform which serve as the basis for a telehealth claim. Learn about eligibility validation.
Code selection and application
We select the appropriate code, add a right modifier and apply a place-of-service code to the documentation, depending on how the payer interprets the claim.
Claim scrubbing for submission
We check every single claim for possible contradictions of the modality, location, and eligibility that may cause telehealth denials so that your claim would be accepted in one go.
Appeal of denials
In case there is a denial of a telehealth claim, we decode it, correct the error and appeal it rather than write it off as a loss. Learn more about denial management.
Monitoring payer rules
We monitor the CMS January updates and payer bulletins so that any changes in rule become known to you even before they hit your denials.
Reporting you can understand
We will provide a clean claim rate, reasons for denial and days in A/R on a consistent basis so that your telehealth revenue stream is clear and not a black box.
What Our Telehealth Billing Service Covers
Telehealth coding and billing is but one part of the revenue cycle, and we optimize everything according to it. The RCM process that codes the visit verifies eligibility prior and pursues the claim afterward without any breaks or gaps between vendors.
Eligibility and consent validation
We check insurance eligibility before the visit and verify documentation includes consent, modality, location, and platform details required for a telehealth claim.
Code selection and application
We select the appropriate codes, apply the right modifiers, and add place-of-service details based on payer requirements.
Claim scrubbing for submission
We review every claim for coding errors, missing details, and contradictions that may cause telehealth denials before submission.
Appeal of denials
We analyze denied telehealth claims, correct errors, and submit appeals to recover revenue instead of writing claims off.
Monitoring payer rules
We monitor CMS updates and payer bulletins to keep your telehealth billing process aligned with changing requirements.
Reporting you can understand
We provide clear reports on clean claim rates, denial reasons, and A/R days so your telehealth revenue stays transparent.
How We Take On Your Telehealth Billing
Telehealth claims assessment
We review your submitted telehealth claims and identify coding issues, requirement gaps, and reasons behind denials or underpayments.
Mapping of payers and states
We analyze payer preferences, modifiers, POS requirements, and state telehealth policies to support accurate claim processing.
Integration with your EHR
We work directly with your existing EHR and practice management system without changing your current workflow.
Sustainable coding, billing and collections
We manage coding, billing, and collections continuously while adapting to CMS and payer policy updates.
Telehealth Billing By Specialty
The rules of telehealth visits depend on the specialty from which they come. We code each by its particular characteristics, not according to one method.
Behavioral and Mental Health Visits
Highest volume of telehealth visits and the most predictable rules, due to permanent coverage at home site and audio only. We code these permanent allowances. See behavioral health billing.
Primary Care and Urgent Virtual Care
The volume of visits and their consistency across payers makes modifier coding and POS code accuracy our main focus on each claim.
Chronic Care Management
Repeat virtual contact visits and where the line is drawn between telehealth and non-telehealth communication service calls for accurate coding.
Specialty Consults
Visits like cardiology, dermatology, and similar specialty visits require a level of care that the service billed is eligible under telehealth for that payer.
Why Practices Choose UControl
Practices choose UControl because this makes telehealth billing a distinct service in that it operates within an entire revenue cycle process and not outside of it. Your virtual visit coding department is the one that ensures the verification of the coverage and the appeal of the denial according to one standard in all fifty states.
Billing-oriented rather than added after the fact
By using the coding and denial specialists responsible for the rest of the revenue cycle, telehealth coding becomes a point of strength and not weakness.
Up-to-date on the regulations
We follow the CMS January list, the 2027 extension, as well as the payer bulletins in order to make sure that your claims comply with the current regulation.
Integrating into EHR
We integrate into your existing environment rather than asking you to undergo a migration process.
Denial recovery as part of the process
We do not write off any denied telehealth claims but rather correct and appeal them due to operating both billing and denial processes.
Explore Frequently Asked Questions
The claims of telehealth are billed for services provided through live video or phone consultation. Telehealth billing is different from in-person billing in two aspects: a modifier stating that the encounter took place virtually and a place of service stating where the patient was located. The modifier and the place of service code are not found on an ordinary office claim and determine whether the claim will get paid.
If you bill for telehealth, the modifier 95 should be appended to the eligible code of a synchronous audio-video encounter on all commercial payers and Medicare Advantage programs. You should append modifier 93 to the eligible code of an audio-only encounter in case of video refusal or unavailability; the reason must be recorded in the medical record. The modifier matches payer policy requirements.
The place of service 10 states that the patient was at his or her home during the telehealth encounter and usually pays the non-facility rate. Place of service 02 states that the. Reporting the wrong one is a frequent denial cause even when the modifier is correct.
The care could be valid and the coding not in compliance with the payer's telehealth policy. The most common reasons include using the wrong place-of-service code, lack of or incorrect modifier, use of an ineligible code virtually, and payer rule non-compliance. Scrubbing all four is done pre-submission to avoid the denial.
Yes. Medicare covers most of its telehealth services until the end of 2027 per the Consolidated Appropriations Act 2026. Home continues to be a legitimate site for delivering non-behavioral telehealth services. Telehealth behavioral health services are permanently covered. Dates keep changing, as Congress keeps amending them.
Yes, in all fifty states. In a virtual first model, claims are submitted from the patient's state, not from the practice state. We crosscheck claims for every state based on the provider's license and payer's enrollment in that state and use the telehealth rules of that state, not Medicare.
No. Medicare does not accept the 2025 telemedicine codes 98000 through 98015, and it still requires E/M codes from the office with an appropriate modifier. While some commercial insurance pays the 98xxx codes, whether you use which code will depend on the insurance. You should always code according to each payer's policy.
There is flexibility in behavioral health telehealth because there are permanent flexibilities. The geographic and home site restrictions have been lifted, and the audio-only provision is permanently allowed under certain circumstances. This gives certainty for the virtual behavioral practices, so we code according to permanent allowances.