"The future of healthcare is not just digital; it's
equitable, accessible, and patient-centered."
Introduction:
In 2025, telehealth has transitioned from a temporary
solution to a permanent fixture in healthcare delivery. The Centers for
Medicare & Medicaid Services (CMS) has extended telehealth flexibilities
through September 30, 2025, allowing providers to offer services to Medicare
beneficiaries regardless of their location, including their homes. However,
starting October 1, 2025, most telehealth services will require patients to be
in an office or medical facility located in a rural area.
This shift necessitates a comprehensive understanding of the
latest billing practices, CPT codes, and insurance requirements to ensure
compliance and optimize reimbursement.
Expert Opinions:
- Dr.
Erin Solis, Manager, Practice & Payment, American Academy of Family
Physicians:
"The introduction of CPT code 98016 replaces the previous virtual check-in code G2012, streamlining the billing process for brief synchronous communications." - Dr.
John Cullen, President, American Academy of Family Physicians:
"The extension of telehealth flexibilities through September 30, 2025, provides an opportunity for providers to adapt to new billing practices and ensure continued access to care for Medicare beneficiaries." - Dr.
Lisa Montgomery, Health Policy and Telemedicine Specialist:
"Telehealth is reshaping how care is delivered, but success depends on understanding the evolving rules around billing and coding. Providers who stay informed can focus on patient care while optimizing reimbursement and compliance."
Key Billing Practices:
- CPT
Codes:
- Synchronous
audio-video: 98000–98007
- Synchronous
audio-only: 98008–98015
- Brief
synchronous communication technology service (CPT code 98016) replaces
the CMS "virtual check-in" visit, which used the CMS Healthcare
Common Procedure Coding System code G2012.
- Place
of Service (POS) Codes:
- POS
10: Telehealth provided in patient's home
- POS
02: Telehealth provided at any other location
- Modifiers:
- Modifier
95: Synchronous telemedicine service rendered via a real-time interactive
audio and video telecommunications system
- Modifier
93: Synchronous telemedicine service rendered via an audio-only
telecommunications system
Insurance Requirements:
- Medicare:
- Continues
to cover telehealth services through September 30, 2025, regardless of
patient location.
- Starting
October 1, 2025, most telehealth services will require patients to be in
an office or medical facility located in a rural area.
- Medicare
Advantage Plans:
- May
continue to offer expanded telehealth services regardless of traditional
Medicare's temporary provisions.
Tips for Providers:
- Stay
Updated:
Regularly review CMS updates and payer policies to ensure compliance with the latest billing practices and coding requirements. - Educate
Staff:
Provide training to administrative and billing staff on new CPT codes, POS codes, and modifiers to minimize billing errors. - Implement
Technology Solutions:
Utilize electronic health record (EHR) systems with integrated coding and billing functionalities to streamline the documentation and billing process. - Monitor
Reimbursement Rates:
Regularly assess reimbursement rates for telehealth services to ensure financial sustainability and identify any discrepancies or underpayments. - Engage
with Payers:
Maintain open communication with insurance carriers to address any billing issues promptly and advocate for fair reimbursement rates for telehealth services.
FAQs:
- Q:
Will telehealth services continue to be covered after September 30, 2025?
- A:
Coverage beyond this date will depend on legislative actions and payer
policies. Providers should monitor updates from CMS and other relevant
authorities.
- Q:
Are there any new CPT codes for telehealth services in 2025?
- A:
Yes, new CPT codes have been introduced for various telehealth services,
including synchronous audio-video and audio-only consultations.
- Q:
How can I ensure proper reimbursement for telehealth services?
- A:
Ensure accurate coding, use appropriate POS codes, and stay informed
about payer policies to facilitate proper reimbursement.
Myth Busters:
- Myth:
Telehealth services are not reimbursed at the same rate as in-person
visits.
- Fact:
Reimbursement rates for telehealth services are comparable to in-person
visits, provided that proper coding and documentation are maintained.
- Myth:
Telehealth is only suitable for certain specialties.
- Fact:
Many specialties can effectively deliver care through telehealth,
expanding access to a broader patient population.
- Myth:
Telehealth services are not subject to the same regulatory requirements as
in-person visits.
- Fact:
Telehealth services must comply with the same regulatory standards as
in-person visits, including billing, coding, and documentation
requirements.
Final Thoughts:
As telehealth continues to evolve, staying informed and
adaptable is crucial for providers to navigate the changing landscape of
billing and reimbursement. By embracing new coding practices, understanding
insurance requirements, and implementing effective strategies, providers can
ensure the sustainability and success of telehealth services in their
practices.
Call to Action:
Stay engaged with the latest developments in telehealth by
subscribing to industry newsletters, attending webinars, and participating in
professional forums. Your proactive involvement will not only enhance your
practice's efficiency but also contribute to the broader conversation shaping
the future of healthcare delivery.
Hashtags:
#Telehealth2025 #MedicalBilling #CPTCodes
#HealthcareInnovation #RemoteCare #MedicareUpdates #TelehealthCompliance
#PhysicianPractice #HealthcarePolicy #Telemedicine
References:
- "New
2025 Telehealth CPT Codes," SMFM, April 24, 2025. Link
- "How
the AMA Meets Need for New Telehealth CPT Codes," American Medical
Association, February 4, 2025. Link
- "How
to Code for Telehealth, Audio-Only, and Virtual-Digital Visits,"
American Academy of Family Physicians. Link
About the Author:
Dr. Daniel Cham is a physician and medical consultant with
expertise in medical technology, healthcare management, and medical billing. He
focuses on delivering practical insights that help professionals navigate
complex challenges at the intersection of healthcare and medical practice.
Connect with Dr. Cham on LinkedIn to learn more: linkedin.com/in/daniel-cham-md-669036285
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