Your provider finished the video visit. Now the claim has to get past one payer that wants POS 10, another that wants modifier 95, and a Medicare edit that rejects the 98000 codes outright. Medicotech’s telehealth medical billing services sort that out claim by claim, so virtual care pays like the in person work it replaces.
We bill telehealth for practices in all 50 states, with payer specific rules built in for Medicare, Texas Medicaid, BCBSTX, Aetna, UnitedHealthcare, and Cigna.
Telehealth medical billing services are outsourced billing and coding for care your providers deliver by live video, phone, or secure messaging. A telehealth billing company verifies virtual visit benefits, codes each encounter, sets the place of service (POS 02 or POS 10) and the modifier (95, 93, FQ, or GT) each payer requires, submits the claim, posts the payment, and appeals denials. The engine matches regular medical billing. The payer rules change faster and vary far more.
Telehealth billing runs on the same workflow as our medical billing services, with an extra layer of checks that only apply to virtual care. If telehealth fills a steady slice of your schedule and those claims deny more often than your office visits, you’re the reader we wrote this page for.
A telehealth claim carries three facts an office claim doesn't: where the patient sat, how the visit happened, and whether this payer covers that combination. Miss one and the payer denies or underpays, often weeks after the visit. Here are the six problems we find most often in first audits:
POS 10 signifies patient at home, while POS 02 represents other telehealth locations. Medicare pays POS 10 at non-facility rates and POS 02 at lower facility rates. Defaulting to 02 silently shaves revenue off visits without triggering denials. Our medical billing services configure templates accurately to capture maximum reimbursement.
Texas Medicaid and commercial plans require modifier 95 for video visits, whereas Medicare relies on POS codes and reserves modifier 93 for audio-only care. Stamping modifier 95 globally trips payer edits. Utilizing certified medical billing and coding services prevents modifier mismatches across payers.
The AMA added telemedicine E/M codes 98000–98015. Medicare assigns these status indicator I (non-covered), while select commercial and Medicaid plans pay them. Submitting the wrong code family results in immediate hard denials. Our structured denial management protocol prevents cross-payer coding mismatches.
Medicare covers audio-only visits for homebound patients when video is unavailable or declined. If medical records lack explicit justification for omitting video, claims fail audit reviews. Tailored support for billing for small practices ensures bulletproof clinical documentation.
Running video visits on standalone platforms separate from the EHR leads to unbilled encounters when schedules are not matched daily against charge entries. Implementing comprehensive revenue cycle management eliminates unbilled visits through daily platform reconciliations.
Telehealth jurisdiction follows patient location. A provider licensed in Florida treating a patient located in Texas must hold active Texas licensure and plan enrollment. Performing pre-visit eligibility and benefits verification flags enrollment gaps before services are delivered.
Most telehealth billing companies charge a percentage of collections. Medicotech typically charges 4 to 8 percent, depending on specialty, claim volume, and payer mix. You pay only when you get paid.
Comparing quotes? Ask every vendor whether the percentage applies to net or gross collections, and whether software, patient statement, or per claim fees sit on top. A low headline rate with four add on fees often costs more than an honest flat percentage.
Everything from the benefit check before the visit to the last patient balance. One team owns each claim from start to finish, and every step adds checks built for virtual care.
Before the patient logs on, our insurance eligibility verification team confirms video coverage, audio-only coverage, copay, and deductible. A plan can cover video and exclude phone visits. We catch that before the visit, not after the EOB arrives.
Some plans require authorization for psychological testing, extended therapy, or specialty consults, whether the visit happens in person or by video. We request it ahead of time and log the number and date range, so the claim doesn't come back as CO-197.
Our CPC certified coders assign the E/M level from medical decision making or total time, then pick the code family each payer accepts: 99202 to 99215 for Medicare, the 98000 series only where a plan has adopted it. They add G2211 where the relationship qualifies and capture 98016 brief check-ins that providers often forget to report. It's the same discipline behind our certified medical coding service.
Every claim runs through payer-specific edits before the 837P leaves: POS 10 versus 02, modifier 95 for video, 93 for audio only, FQ for audio-only behavioral care at RHCs and FQHCs, and GT for the few plans that still ask for it on asynchronous services. A coder fixes mismatches before submission, since those mismatches drive CO-4 and CO-5 denials.
We match your telehealth schedule against posted charges every business day. If a video visit happened and no charge exists, your team hears about it the same day, while the provider still remembers the encounter.
Our denial management team appeals every telehealth denial and traces it back to the step that caused it. When a front desk script or an EHR template sits behind a pattern, we tell you exactly what to change so the denial stops repeating.
We post every ERA and EOB against the expected rate for that code, POS, and payer. Underpaid claims get a corrected claim or an appeal, not a write-off.
Your providers can't bill telehealth to a plan that hasn't enrolled them. We handle provider enrollment and CAQH upkeep in every state where your patients live, and we confirm enrollment before the first claim goes out.
You get weekly KPI reports showing denial rate, days in A/R, clean claim rate, and collections, with telehealth split from in-person work and audio-only split from video. You'll see which visit type earns and which one leaks.
It’s been a bumpy year. Medicare’s telehealth flexibilities lapsed on October 1, 2025 during the government shutdown, and CMS had contractors return many home telehealth claims with CARC 16 and RARC M77. Congress restored the flexibilities retroactively, they lapsed again briefly on January 31, 2026, and then the Consolidated Appropriations Act, 2026 (signed February 3, 2026) extended them through December 31, 2027.
Practices that kept billing through the lapses without a plan spent weeks resubmitting returned claims. Practices with a biller watching the calendar held those claims, then released them the day the extension took effect. That’s the whole difference a telehealth specialist makes, in one story.
The extension keeps these Medicare rules in place through 2027:
The CY 2026 Physician Fee Schedule added permanent changes on top. CMS removed frequency limits for subsequent inpatient visits, nursing facility visits, and critical care consults by telehealth. It made virtual direct supervision through real time audio and video permanent for most services outside a 010 or 090 global period, dropped the provisional category on the telehealth services list, and set the originating site fee (Q3014) at $31.85. Practitioners who only practice virtually from home must also enroll that home address as their practice location.
Medicare bills a video visit with the regular office E/M code plus a telehealth place of service. Commercial plans and state Medicaid programs each write their own rules, and many still want modifier 95 or accept the newer 98000 codes. The table shows how we code each situation for 2026 dates of service.
How we code telehealth claims by payer type (2026 dates of service)
| Situation | Medicare Part B | Texas Medicaid | Commercial plans (BCBSTX, Aetna, UHC, Cigna) |
|---|---|---|---|
Video visit | 99202 to 99215 with POS 02 or 10. Modifier 95 only in narrow cases. | E/M or service code with modifier 95 | 99202 to 99215 with modifier 95, or 98000 to 98007, depending on the plan |
Audio only visit | E/M code with modifier 93. Patient at home, provider video capable, patient can't or won't use video. | Modifier 93 on covered services | Plan by plan. State regulated Texas plans may exclude audio only services. |
Brief virtual check in | 98016 | Check the current TMPPM | Varies by plan |
98000 to 98015 codes | Not payable (status indicator I) | Confirm against the current TMPPM before use | Accepted by some plans, sometimes at different rates |
Place of service | POS 10 at home (nonfacility rate). POS 02 elsewhere (facility rate). | POS 10 at home, POS 02 elsewhere, per MCO bulletins | Most follow the CMS split. BCBSTX adopted it for commercial claims. |
Home coverage window | Through December 31, 2027, unless Congress extends it | Set by state policy, not the Medicare deadline | Set by each plan contract |
Sources: CMS telehealth guidance, AAFP telehealth coding guidance, Texas HHSC teleservices policy, and published BCBSTX and Aetna Texas telehealth policies. Payer rules change often, so we recheck each plan’s policy file whenever it publishes an update.
We bill telehealth for any specialty that sees patients virtually. The heaviest volume comes from behavioral health, psychiatry, primary care, internal medicine, and rural clinics.
Psychotherapy codes turn on minutes. 90834 needs 38 to 52 minutes and 90837 needs 53 or more, so a dropped video session means billing only the time the note supports. Medicare covers telemental health from home permanently, and audio only therapy from home stays billable with modifier 93. Our mental health billing team works these rules every day.
Here's a real pattern we watch for. A psychiatric follow up starts on video, the connection freezes at minute nine, and the psychiatrist finishes by phone. The note has to say that, with times, because the modality changes the modifier. An E/M visit paired with the 90833 psychotherapy add on code also needs separate time for each service, or the add on denies. With the DEA deadline close, psychiatry billing needs extra attention this quarter.
Medicare pays annual wellness visits by video, and G2211 can ride on telehealth office visits for patients your practice follows over time. Chronic care practices also pick up 98016 check ins that rarely make it onto a superbill.
Behavioral visits by video or phone bill as clinic visits with modifier 95 or FQ. Non behavioral telehealth goes out under G2025 at a special rate CMS has renewed year by year. We keep the two streams apart so neither pays at the other's rate.
Synchronous audiovisual encounters require modifier 95, while audio-only visits use modifier 93. Texas HHSC encourages live video over telephone visits where feasible, and clinical documentation must strictly meet the same standards required for equivalent in-person encounters.
Most Texas Medicaid beneficiaries are enrolled across STAR, STAR+PLUS, STAR Kids, or STAR Health plans. Each MCO issues independent billing bulletins—for instance, BCBSTX's Medicaid plan requires POS 10 for home visits and POS 02 for all other telehealth service locations.
Texas Insurance Code Chapter 1455 prohibits state-regulated plans from denying coverage solely because care was delivered remotely, though plans may omit coverage for audio-only or asynchronous care. Aetna’s Texas policy mandates POS 02 with modifier 95 for live video or GT for asynchronous visits.
Telehealth payment parity remains a fluctuating legislative issue in Austin, while self-funded ERISA plans fall outside state insurance mandates. Each payer contract terms must be continuously audited against actual ERA posted payments rather than assuming parity with in-office E/M rates.
Physicians treating patients physically located within Texas must hold an active Texas medical license and active health plan enrollment. Pre-visit checks confirm active state licensure and MCO network status prior to initiating remote visits.
The Texas Division of Workers' Compensation (DWC) adopts Medicare's telehealth billing policies by direct reference. Consequently, workers' comp telehealth claims must adhere strictly to Medicare logic and modifiers rather than standard commercial payer templates.
We work inside your existing EHR and practice management system. No forced migration. No disruption to your current workflow.
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Your video platform matters less than you’d think. We bill from the encounter note and the schedule, so Doxy.me, Zoom for Healthcare, or your EHR’s built in video all work the same way for us.
Outsource when telehealth makes up a steady share of your visits and nobody on staff owns payer telehealth rules full time. Keep it in house if you bill one or two payers, employ a trained coder, and your telehealth denial rate already matches your office visit rate.
In house versus outsourced telehealth billing
| Factor | In-House Billing vs. Medicotech |
|---|---|
Cost structure | In-house: Salary, benefits, billing software, training, and turnover. Medicotech: Percentage of collections, typically 4 to 8 percent, no setup fee. |
Telehealth rule tracking | In-house: Whoever has time that week. Medicotech: A team that tracks CMS, Texas HHSC, and payer bulletins weekly. |
When your biller quits | In-house: Claims stop until you hire and train. Medicotech: No gap in coverage. |
Payer specific edits | In-house: Manual memory and sticky notes. Medicotech: Built into scrubbing on every claim. |
Reporting | In-house: Whatever your EHR exports. Medicotech: Weekly KPIs with telehealth split out. |
New state expansion | In-house: A separate project nobody owns. Medicotech: Enrollment handled alongside billing. |
Outsourcing also pulls telehealth into your broader revenue cycle management, so virtual and in person revenue finally show up in one report instead of two spreadsheets that never agree.
Ask questions only a telehealth specialist can answer well. While generalists offer vague answers about POS and modifiers, a true specialist responds with specific payer guidelines and regulatory timelines.
We analyze your last 90 days of telehealth claims, payer mix, and A/R aging to identify denied or underpaid visits.
We sign a Business Associate Agreement first, followed by securing role-based access to your EHR, clearinghouse, and portals.
Our team builds custom scrubbing rules for POS codes, modifiers, code families, and audio-only guidelines per payer.
We review your clinical documentation templates against payer guidelines and verify provider enrollment across states.
New claims deploy under custom scrubbing rules while old A/R is worked in parallel, with weekly performance reports starting week one.
Telehealth medical billing services are outsourced billing and coding for care delivered by video, phone, or secure messaging. The billing company verifies telehealth benefits, codes each visit, sets the place of service and modifier each payer requires, submits claims, posts payments, and appeals denials. Medicotech handles every step for practices in all 50 states, including multistate provider enrollment.
Most telehealth billing companies charge a percentage of collections. Medicotech typically charges 4 to 8 percent depending on specialty, volume, and payer mix, with no setup fees and no long term contracts. Before you sign with anyone, ask what the percentage covers and whether software, statement, or per claim fees sit on top of it.
Yes. The Consolidated Appropriations Act, 2026, signed February 3, 2026, extended Medicare’s telehealth flexibilities through December 31, 2027, including visits to patients at home and audio only care. Telemental health from home is permanent under earlier law. Commercial plans and Medicaid programs set their own coverage, so coding still varies by payer.
Use POS 10 when the patient is at home and POS 02 when the patient is anywhere else, such as a clinic or nursing facility. Medicare pays POS 10 at the nonfacility rate, which matches an office visit, and POS 02 at the lower facility rate. Most commercial plans, including BCBSTX, follow the same split, but check each payer’s policy.
Usually not on professional claims. Medicare identifies telehealth through POS 02 or POS 10 and requires modifier 93 for audio only care. Modifier 95 still applies in narrow cases, such as hospital outpatient practitioners billing for a patient at home. Texas Medicaid and many commercial plans do require modifier 95 on video visits, so the answer depends on the payer.
No, except 98016. CMS assigned codes 98000 through 98015 a status indicator of I, so Medicare denies them. Bill Medicare video visits with 99202 to 99215 and the correct place of service, and use 98016 for brief virtual check ins. Some commercial plans and state Medicaid programs accept the 98000 series, so we track adoption payer by payer.
Yes, with conditions. Medicare pays audio only visits through December 31, 2027 when the patient is at home, the provider can use video, and the patient can’t or won’t. The note must say so, and the claim carries modifier 93. Texas Medicaid also uses modifier 93, while state regulated Texas commercial plans may exclude audio only services.
Yes, for Medicare. You can add G2211 to an office or outpatient E/M visit delivered by telehealth when the provider serves as the patient’s continuing focal point for care or manages a serious or complex condition over time. Medicare won’t pay it with modifier 25 except alongside certain preventive services. Commercial plans write their own rules.
Texas Medicaid requires modifier 95 on services delivered by synchronous audiovisual technology and modifier 93 on audio only services. Documentation must match a comparable in person visit, and HHSC encourages video over phone where possible. Most members belong to managed care plans such as STAR and STAR+PLUS, and each MCO adds its own POS and authorization rules.
Not across the board. Chapter 1455 of the Texas Insurance Code bars state regulated plans from refusing coverage just because care happened remotely, but payment parity has been a recurring legislative fight, and self funded employer plans fall outside state insurance law. We check the telehealth terms in each contract and compare every payment against them.
Usually only if the provider holds a license, or another legal permission, in the state where the patient sits during the visit. Compacts such as the Interstate Medical Licensure Compact and PSYPACT shorten that process. After licensure, the provider still needs enrollment with the patient’s plan in that state. We handle that enrollment so claims start paying sooner.
Yes. HHS treats billing and claims processing as business associate work, so a telehealth billing company must sign a business associate agreement before it receives patient data. Medicotech signs a BAA before our team sees a single claim. If a vendor asks for claim files first and paperwork later, your practice carries that risk.
For most payers, the terms mean the same thing: care delivered by video or phone. Texas law draws a line, though. A telemedicine medical service comes from a physician or someone working under physician delegation, while a telehealth service comes from other licensed health professionals. Texas Medicaid and several Texas payer policies apply different rules to each.
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