Telehealth Billing – What you should know exactly?


Tele-health billing has been the talk of the trend on national media during the past few months of the increase of the COVID-19 pandemic. Even before the new coronavirus hit the people in the USA, 76% of the US hospitals were offering telehealth medicine to patients from distant locations.

Telehealth refers to telemedicine encompasses patient and physician’s communication through tele tools such as phone calls, emails, and text messages. On the other way around, telemedicine even caters remote clinical services through using technologies for remote patient monitoring and live video conferencing as well.

Telehealth Billing
Telehealth Billing

Though telemedicine is in practice, there are certain guidelines imposed by the CMS pertained to telehealth, along with some variations in reimbursement of claims as well, from payer to payer. To avoid the risk of the increase in the COVID-19 due to the current condition, extension has been provided to Medicare enrolees to get in touch with physicians on emergency and no other option cases only.

What procedure does telehealth billing follow according to new rules imposed by CMS?

  • For initiating reimbursement of telehealth services, an interactive audio and video telecommunications system that enables communication between the service provider and the beneficiary should be in real-time.
  • There is a change in the category of services due to the pandemic outbreak, which needs to be followed properly before claims submission/reimbursements. It may not completely change to the existing telehealth billing rules, yet there are notable changes as well.
  • Earlier to COVID-19, telehealth was considered as a benefit of coverage only if the originating site was outside the country of a Metropolitan Statistical Area, but now there is more liberalness to many medical practices, health centres, individual practitioners, etc.
  • Prior to COVID-19, all doctors, nurse practitioners, nurse-midwives, clinical nurse specialists, certified and registered nurse anesthetists, etc. were eligible to receive telehealth reimbursements, but now telehealth billing is all about distant site, where the provider who delivers the service is located.

Some of frequently used telehealth billing codes for your knowledge

  • New patient visits: 99201–99205
  • Consultations: 99241–99245
  • Codes for behavioural change interventions: 99406– 99408
  • Established patient visits: 99212–99215

Changes in telehealth coding due to COVID-19:

In case you are an individual telehealth service provider, then according to CMS, these are the codes you should follow for evaluation and management visits, to Medicare:

  • 99421: If the patient is an established one and opting for online digital evaluation and management service for up to 7days, and the consultation lasts for 5–10 minutes during the 7days, then the provided code should be used.
  • 99422: In the same pattern, if the patient’s consultation lasts for 11–20 minutes, then apply this code.
  • 99423: In case the duration of tele-consultation exceeds 21 or more minutes, then this code has to be considered.

If you are a commercial player, then you might be required to use Modifier 95 on a need basis for tele-health billing with Medicare. However, providers will make use of the same POS code like how they use it for in-person services, as long as the rules remain imposed and the COVID-19 outbreak continues.


Changes in telehealth billing and coding are common anytime no matter whatever the situation we are. But keeping those changes in tele-health coding updated regularly is highly critical for medical practices, due to the increase in the number of patients who opt for telemedicine during this pandemic.

Therefore, to control such complex situations and streamline to telehealth billing process, thinking of outsourcing will be a great choice. 24/7 Medical Billing Services offer a wide range of medical billing and coding services at high quality. The company is especially good at staying in line to the changing rules and trends in medical billing and coding, to provide a great service to medical practices.


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