Telehealth CPT Codes (2025–2026): Updated List with Modifiers

Telehealth has transformed how patients receive care, making it faster and more convenient to connect with healthcare providers from anywhere. As video visits, phone consultations, and digital check-ins continue to grow, accurate telehealth billing remains essential for compliance and reimbursement.

To keep pace with evolving care delivery models, the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) introduced updated telehealth CPT codes and modifiers for 2025. As we move into 2026, many of these policies remain active, while payers continue to evaluate long-term telehealth coverage.

This guide covers the latest telehealth CPT codes, modifiers, and Medicare billing rules for 2025–2026, helping providers avoid denials and stay compliant.

🔔 January 2026 Update

Telehealth billing policies continue to evolve in 2026. While most 2025 CPT codes and modifiers remain in effect, CMS and commercial payers are reviewing long-term reimbursement policies for audio-only and video-based telehealth services. This guide reflects current 2026 billing practices, with updates added as new CMS rules are released.

Telehealth CPT Codes & Modifiers for 2025–2026

A new set of telehealth-specific CPT codes replaced temporary pandemic-era codes beginning in 2025. These codes follow the Evaluation and Management (E/M) structure and apply to telemedicine services delivered via audio-video or audio-only communication.

1. Audio-Video (Two-Way Live Communication)

These codes are applied when there is real-time audio and video communication between the provider and the patient. These can be billed for new or established patients and follow the same time or MDM-based selection rules as in-person E/M visits.

For New Patients (Audio-Video):

• 98000: Equivalent to 99202 (Straightforward MDM or 15 mins)
• 98001: Equivalent to 99203 (Low MDM or 30 mins)
• 98002: Equivalent to 99204 (Moderate MDM or 45 mins)
• 98003: Equivalent to 99205 (High MDM or 60 mins)

For Established Patients (Audio-Video)

• 98004: Equivalent to 99212 (Straightforward MDM or 10 mins)
• 98005: Equivalent to 99213 (Low MDM or 20 mins)
• 98006: Equivalent to 99214 (Moderate MDM or 30 mins)
• 98007: Equivalent to 99215 (High MDM or 40 mins)

These codes can be billed based on total time or Medical Decision Making. Modifier 95 is not required, as the code descriptor already indicates telehealth.

2. Audio-Only (Phone Call-Based Consultations)

These codes are used when services are delivered exclusively via phone (audio only). They are ideal for patients who cannot or do not wish to use video. A minimum of 10 minutes of medical discussion is mandatory, even if selecting the code based on MDM.

For New Patients (Audio-Only)

• 98008: Equivalent to 99202 (Straightforward MDM or 15 mins)
• 98009: Equivalent to 99203 (Low MDM or 30 mins)
• 98010: Equivalent to 99204 (Moderate MDM or 45 mins)
• 98011: Equivalent to 99205 (High MDM or 60 mins)

For Established Patients (Audio-Only)

• 98012: Equivalent to 99212 (Straightforward MDM or 10 mins)
• 98013: Equivalent to 99213 (Low MDM or 20 mins)
• 98014: Equivalent to 99214 (Moderate MDM or 30 mins)
• 98015: Equivalent to 99215 (High MDM or 40 mins)

Modifier 93 is required by Medicare and many payers to indicate audio-only telehealth services. Documentation should confirm that audio-video was available but not used due to patient limitations or preference.

3. New Brief Communication Code

CPT code 98016 was introduced in 2025 as the CPT-based equivalent of Medicare’s G2012 brief communication service. It is used to report brief communication technology-based services, such as a quick audio or video check-in between a provider and an established patient. The interaction must last between 5 and 10 minutes and can either be initiated by the patient or be a follow-up to an earlier concern.

However, it is essential to note that this code cannot be billed if the interaction is related to a prior Evaluation and Management (E/M) service provided within the previous 7 days, or if it leads to an E/M visit within the next 24 hours (or the soonest available appointment). CPT 98016 is best used for short consultations to assess whether further in-person or telehealth care is required.

4. Medicare Coding Guidelines

Despite the new codes, Medicare has not adopted the 98000–98015 series. Instead, they continue with their policies:

• Use traditional office E/M codes (99202–99215) for telehealth
• Place of Service (POS):

POS 10: Telehealth provided in the patient’s home – reimbursed at non-facility rate

POS 02: Telehealth provided in other locations – reimbursed at facility rate

• Modifier 93 must be appended for audio-only services
• No modifier is required for audio-video services

• GT modifier may still be applicable in some Medicare setups (legacy requirement)

5. Medicaid and Commercial Payer Guidelines

When it comes to billing telehealth services, Medicaid and commercial payers differ significantly in how they handle the new 98000-series CPT codes. Though some private insurance plans and Medicaid programs have adopted these codes and provide appropriate reimbursement, others continue to rely on traditional in-person Evaluation and Management (E/M) codes. Due to this inconsistency, providers and billing teams need to verify the telehealth billing policies of each payer prior to submitting claims. In particular, Medicaid coverage is regulated at the state level, which means policies can vary widely, especially concerning audio-only versus audio-video telehealth services.

6. Digital Health Services

  6.1. E-Visits (Online Digital E/M Services)

E-visits are designed for patient-initiated interactions through secure digital platforms such as online patient portals or email. These are non-face-to-face services where communication may span over seven days, and the total time spent by the provider determines the appropriate billing code. All communication must be documented and stored, and these services cannot be billed if they lead to an in-person or telehealth encounter within 24 hours or if related to another E/M service within the previous 7 days. The codes that apply include:

• 99421: 5–10 minutes
• 99422: 11–20 minutes
• 99423: 21 or more minutes

  6.2. Virtual Check-Ins

Virtual check-ins are short consultations meant to decide whether a patient needs a face-to-face or telehealth appointment. Such interactions can be conducted via an audio or audio-video interface and are designed to address specific patient issues promptly. Similar to e-visits, these services cannot be billed if they are pertaining to a recent E/M visit within the last 7 days or lead to a telehealth or in-person visit within the next 24 hours. Such codes include:

• 98016: Brief audio or audio-video communication for 5–10 minutes
• G2252: Extended brief communication for 11–20 minutes
• G2010: Review of recorded video/images submitted by a patient, with provider response required within 24 business hours

These digital health options enhance access while supporting appropriate clinical decision-making between full visits.

7. Telehealth Modifiers

Modifiers are essential in telehealth billing as they define the manner in which a service was provided in order to receive proper and maximum reimbursement from payers.

• Modifier 95

Modifier 95 is used to indicate that a telehealth service was delivered through synchronous, real-time audio and video communication. It is commonly used by commercial payers to differentiate video-enabled visits from in-person services. However, it is important to note that Medicare does not require Modifier 95, as telehealth identification is handled through place-of-service and modality-specific rules.

• Modifier 93

Modifier 93 identifies services provided via audio-only communication, such as phone consultations. It is required by Medicare and many other payers to distinguish these visits from video-based services. Documentation must clearly state that audio-video was available for compliance. Still, the patient either opted for audio-only or was unable to use video technology to make phone communication the chosen method.

• Modifier GT

Modifier GT was once used by Medicare, but is no longer necessary. Such modifiers represent those services provided through interactive audio and video telecommunications. Even though it has been retired from Medicare guidelines, commercial payers might continue to request this modifier as part of their billing. Therefore, it is necessary to check payer-specific needs prior to usage.

• Modifier FQ

Modifier FQ is reserved for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) providing audio-only services. It adds further clarity to billing in underserved areas and can be used with Modifier 93 if necessary. This modifier helps ensure accurate reimbursement and compliance for telehealth services delivered in rural healthcare settings.

What should Providers Do in 2026?

As telehealth continues to evolve, providers must stay proactive in adapting their billing practices to avoid denials and ensure accurate reimbursement. For Medicare telehealth services in 2026, providers should continue using traditional office E/M codes (99202–99215), applying POS 02 or POS 10 and Modifier 93 for audio-only visits, unless CMS issues new guidance. Where applicable, adopt the new 98000–98015 codes for commercial and Medicaid payers that support them, and utilize 98016 and G2252 for brief communications and virtual check-ins.

With payer-specific policies constantly shifting, training telehealth billing staff to track these differences is vital. You can also outsource telehealth billing and coding to an expert billing team like 24/7 Medical Billing Services. Our team can help your practice stay compliant, reduce claim denials, and maximize telehealth revenue by ensuring every code and modifier is used correctly based on the latest updates.

FAQs

Q1. Can telehealth services be billed across state lines?

It depends on licensure laws and payer policies for interstate care.

Q2. Are remote patient monitoring services part of the telehealth CPT updates?

They fall under different CPT codes and billing guidelines.

Q3. Is patient consent required for all telehealth services?

Consent is typically required and should be documented.

Q4. Is real-time documentation required during telehealth encounters?

Accurate and timely documentation is crucial for compliance.

Q5. Can a single visit be billed as both telehealth and in-person on the same day?

Telehealth and in-person visits generally cannot be billed together for the same encounter.