The Essentials of Telehealth Billing
Billing for live, synchronous telehealth visits generally involves using the same CPT codes as in-person visits (e.g., 97161 for an eval, 97110 for ther-ex). The key difference is the use of a telehealth Place of Service (POS) code, typically 02 or 10, and often a modifier like 95. Using the wrong POS code is the most common reason for telehealth denials.
Billing for Remote Telehealth Coaching
Remote coaching and patient education delivered via telehealth can be billed, but it must be structured correctly. If you spend significant time on education, this can be captured using CPT code 98960 (Education and training for patient self-management). This is a time-based code and requires detailed documentation of the topics covered and time spent.
Payer Policies are Key: Not all payers cover self-management education codes when delivered via telehealth. Always verify the patient's benefits and the payer's specific telehealth policy before billing.
