Telemedicine has evolved from a convenient alternative to a cornerstone of modern healthcare. As we enter 2025, providers must stay ahead of complex billing rules, payer updates, and compliance requirements. A thorough billing checklist can help practices avoid costly mistakes and ensure faster reimbursements.
Here’s your ultimate telemedicine billing checklist for 2025.
- Verify Patient Eligibility and Coverage
Before the virtual visit, confirm:
- Patients’ insurance covers telemedicine.
- Visit type is approved (e.g., video, phone, asynchronous).
- Provider is credentialed and enrolled with the payer.
- State licensure compliance if practicing across states.
Pro tip: Use your practice management software or verify via payer portals.
- Confirm Telemedicine CPT/HCPCS Codes for 2025
Stay updated with the 2025 changes in CPT and HCPCS codes. Common codes include:
- 99421–99423 (online digital evaluation)
- 99441–99443 (telephone E/M services)
- 99202–99215 (office visits via telehealth)
- G2012, G2252 (virtual check-ins)
New in 2025: Some payers have introduced bundled codes for chronic care via telehealth; check individual payer bulletins.
- Use Appropriate Place of Service (POS) Codes
Correct POS codes indicate where the service occurred:
- POS 02 – Telehealth Provided Other than in Patient’s Home
- POS 10 – Telehealth Provided in Patient’s Home
This impacts reimbursement, so accuracy is crucial.
- Apply the Right Modifiers
Modifiers clarify how the service was delivered:
- Modifier 95 – Synchronous telemedicine service rendered via real-time audio and video.
- Modifier GT – Via interactive audio and video (some private payers).
- Modifier GQ – Asynchronous telecommunication (store-and-forward).
- Modifier CR – Catastrophe/disaster-related (only during emergencies).
- Document According to Guidelines
Comprehensive documentation should include:
- Patient consent for telehealth.
- Start and end time of the visit.
- Technology used (e.g., HIPAA-compliant platform).
- Medical necessity and provider notes.
- Location of both the patient and provider.
Pro tip: Use an integrated EHR like EHRCentral for seamless documentation and billing workflows.
- Stay Informed on Payer Policies
Each insurer has different billing requirements:
- Medicare vs. Medicaid vs. Private Payers.
- Rules for asynchronous visits, remote monitoring, and audio-only visits.
- Reimbursement parity laws (some states require equal pay for telehealth and in-person).
Check payer policy manuals quarterly.
- Monitor Denials and Rejections
Track billing performance with KPIs:
- First-pass claim acceptance rate.
- Top denial reasons (e.g., incorrect modifier, eligibility issues).
- Average reimbursement turnaround.
Use billing software like EHRCentral to automate tracking and improve cash flow.
- Educate Your Front Desk and Billing Staff
Even the best systems fail without team alignment:
- Train staff on intake procedures for telehealth.
- Ensure billers understand 2025 updates.
- Keep scripts for patient communication regarding costs and coverage.
- Conduct Regular Internal Audits
Review random claims monthly to check for:
- Compliance gaps.
- Missing modifiers.
- Incorrect POS codes.
- Underbilling or overbilling patterns.
Consider third-party auditing services or compliance tools.
- Leverage Technology for Efficiency
Modernize your operations:
- Use telehealth-integrated EHRs and billing platforms.
- Automate eligibility verification.
- Enable digital consent forms and payment collection.
Platforms like mHospital offer end-to-end telemedicine practice support, from credentialing to billing.
Final Thoughts
Telemedicine continues to transform how we deliver care, but it also brings billing challenges. A well-structured checklist is not just a tool; it’s a necessity in 2025.
By following this ultimate telemedicine billing checklist, you can improve reimbursement rates, reduce denials, and focus on what truly matters: patient care.