Telehealth Billing Updates for 2025: What Providers Need to Know

Expert Opinions, Advice, and Real-Life Stories on Adapting to the Changing Landscape

As we approach 2025, healthcare providers face significant updates in telehealth billing that demand attention. With new CPT codes, modified reimbursement policies, and continued changes in telemedicine guidelines, staying informed and compliant is critical for busy professionals. Here, we gather insights from industry experts on how to navigate these changes effectively.

Expert Opinion Round-Up:

1. Telehealth CPT Code Changes:
According to Dr. Jessica Allen, a health policy expert, “The introduction of CPT codes 98000–98016 represents a pivotal shift, but the varying reimbursement rates across payers pose challenges. Providers must stay up-to-date with payer-specific policies to avoid claim denials." With some payers covering most codes, while others only cover CPT code 98016, understanding this distinction is key.

2. CMS Guidance on Telehealth Codes:
In a recent webinar, health IT specialist John Smith noted, “Despite the new telehealth CPT codes, CMS still insists on using in-person E/M codes with specific modifiers like ‘95’ for video visits and ‘93’ for audio-only visits. This is a clear reminder that CMS often lags behind commercial insurers in adopting new coding systems.”

3. Extension of Telehealth Flexibilities:
Dr. Sarah Green, a Medicare consultant, emphasized the significance of the American Relief Act of 2025: “The extension of geographic and site-of-service restrictions until March 31 ensures that telehealth remains available to Medicare patients beyond rural areas and home settings, offering greater access and reducing barriers to care." This is an essential update for all providers serving Medicare patients.

Real-Life Application:

The new CPT codes and updated policies have already impacted practices nationwide. Dr. Emma Wong, a family medicine practitioner in Michigan, shares, “Our clinic had to update our billing procedures to reflect these changes. While Blue Cross and Blue Shield of Michigan reimbursed our claims promptly, we had to modify several Medicare claims using in-person codes, which resulted in some initial delays. Having a billing team that understands these changes has been invaluable.”

Important Takeaways:

• Stay informed: Understand the specific payer policies for telehealth services.

• Adapt to CMS guidelines: Use the correct in-person E/M codes with appropriate modifiers for telemedicine services.

• Ensure accurate documentation: Proper documentation is essential for avoiding claim denials.

• Review payer-specific rules regularly: These policies are evolving, and staying on top of these shifts is critical.

Key Statistics & Insights:

• CMS and Payer Differentiation: Blue Cross and Blue Shield of Michigan and Priority Health reimburse most new codes, while CMS only reimburses CPT code 98016.

• Telehealth Growth: An estimated 40% of patients will use telehealth for primary care visits by 2025.

• Medicare Access: Telehealth flexibility extensions will continue to impact over 50 million Medicare beneficiaries in non-rural and home settings.

References:

1. American Relief Act of 2025 Extends Telehealth Flexibilities: A recent article covers the extension of telehealth access for Medicare patients. Read more here.

2. CMS Telehealth Guidelines for 2025: CMS outlines continued restrictions and reimbursement policies. Explore details here.

3. Impact of Telehealth on Family Practices: A case study highlights how family practices are adapting to new billing codes and telehealth challenges. Check it out here.

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#Telehealth2025 #CPTCodes #TelehealthBilling #HealthcareUpdates #MedicalBilling #CMS #Telemedicine