Struggling to get your head around telehealth billing? If CPT codes, modifiers, and place of service (POS) codes feel like a language you never learned, you are not alone.
Many practitioners find the administrative side of their work a major source of stress. Getting billing wrong means delayed payments and extra admin work nobody has time for.
But what if you could master telehealth billing for good? This guide breaks down the essentials for 2025 in plain English. We'll demystify the codes you need to know, show you how they fit together, and introduce a tool that makes the whole process a doddle.
Understanding the Building Blocks of Telehealth Billing
Think of a telehealth claim as telling a story to an insurance company. To get paid correctly, your story needs three key parts: the what, the how, and the where.
Getting this combination right is the secret to clean claims and timely reimbursement.
Cracking the CPT Code: What Service Did You Provide?
Current Procedural Terminology (CPT) codes are used to describe the service you rendered. While there are some old, specific codes for telephone therapy, most insurance companies prefer you to use the standard psychotherapy codes you're already familiar with, along with a telehealth modifier.
Common Mental Health CPT Codes for Telehealth in 2025
For most individual psychotherapy sessions delivered via telehealth, you will use the same time-based CPT codes as you would for an in-person visit.
It is vital to document your session times accurately to justify the code you use.
The Magic of Modifiers: How Was the Service Delivered?
Modifiers are two-character codes that add extra information to your CPT code. For telehealth, they are essential for telling the payer that the service was provided remotely.
Modifier 95: The Go-To for Video Sessions
Modifier 95 is your most important tool for video telehealth billing. Its official description is a “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system”.
In simple terms, you should use Modifier 95 when:
For example, billing a 45-minute video therapy session would look like this: CPT code 90834 with modifier 95. Proper documentation is key; always note the date, time, your location, the client's location, and that you obtained their consent for a telehealth visit.
Modifier 93: For Audio-Only Sessions
Sometimes, a video connection isn't possible. In these cases, Modifier 93 is used to indicate a session was conducted via audio-only. This is particularly relevant for Medicare and some commercial payers who have specific rules for audio-only services. Always check with the payer first, as not all plans cover audio-only sessions, and some may require you to document why a video connection wasn't used.
Place of Service (POS) Codes: Where Did the Session Happen?
The Place of Service (POS) code tells the insurance company where your client was located during the session. This has become more specific in recent years. For a traditional in-person session in your office, you would use POS code. For telehealth, there are two main codes you need to know.
POS Code 02: Telehealth Outside the Home
This code signifies that the service was provided via telehealth, but the client was not in their home. For example, they might be in their car, at their office, or another secure location.
POS Code 10: Telehealth in the Patient's Home
This is a newer code that provides more specific detail. Use POS code 10 for telehealth when the patient is located in their private residence during the session. As of 2024, Medicare pays for services billed with POS 10 at the higher, non-facility rate, which is great news for practitioners.
The key takeaway is that the combination of CPT, modifier, and POS code must be correct. Different insurance companies can have slightly different rules, so it is always wise to confirm their specific requirements.
Putting It All Together: A 2025 Telehealth Billing Example
Let's make this real. Imagine you have just finished a 60-minute individual psychotherapy session with a client who was at home, and you used a secure video conferencing platform.
Here is how you would bill it:
This simple combination tells the insurer the full story: what you did, how you did it, and where it happened.
Tired of the Guesswork? Carepatron Has a Better Way
Feeling overwhelmed? That's understandable. Keeping track of codes, modifiers, and varying payer rules is a huge administrative burden, and it is a leading cause of practitioner burnout. This is where a modern, all-in-one practice management software becomes a game-changer.
Imagine a system that does the heavy lifting for you. Carepatron is designed to be the expert business partner you deserve, simplifying the complexities of running a practice so you can focus on your clients.
How Carepatron Automates Your Billing:
By moving away from clunky, outdated systems, you can reduce administrative stress and reclaim valuable time.
Your 2025 Telehealth Billing Checklist
To ensure clean claims and prompt payments in 2025, follow these simple steps:
Mastering telehealth billing is an achievable goal. By understanding the core components and using smart tools to automate the process, you can ensure your practice is financially healthy, leaving you more time and energy for the work that truly matters.
