Telehealth Billing: 6 Checks to Reduce Denials

Telehealth billing requires more than adding a modifier to a familiar procedure code. Your team must confirm coverage, follow the payer’s instructions, and submit a claim that matches the documented visit.

A patient may receive care through video or a phone call. However, those visits can have different coverage and billing requirements.

Errors can begin before claim submission. Staff may miss the patient’s location, select an unsupported code, or apply a rule from the wrong payer.

A clear workflow helps your practice identify these gaps before they create more work.

Why Telehealth Billing Claims Get Denied

Telehealth claims can encounter problems when the service, documentation, and claim details do not align.

Common issues include:

• The plan does not cover the service through the method used.
• The payer does not accept the submitted code.
• The place-of-service code does not match the patient’s location.
• A required modifier is missing or incorrect.
• The record does not support the billed service.
• Staff use instructions that do not apply to the date of care.

Start with the payer’s stated reason. Then find the step where the incorrect or missing information entered the workflow.

Use these six checks to review your process.

1. Confirm Coverage for the Service and Visit Type

First, check whether the patient’s plan covers the planned service through telehealth.

Coverage may depend on:

• The service performed
• Whether the visit uses video or audio only
• The provider’s type and participation status
• The patient’s location
• Referral or authorization requirements
• The date of service

A service covered in person is not automatically covered remotely. Likewise, coverage for a video visit does not establish coverage for a phone visit.

Medicare publishes a list of telehealth services. Review that list alongside the applicable coverage conditions and billing instructions. Commercial and Medicaid plans may have different requirements. CMS

Record unresolved questions before the appointment. An active insurance response alone does not confirm that the planned telehealth service will be paid.

Question to ask: Who checks service-specific coverage and handles unclear findings?

2. Check Which Codes the Payer Accepts

The AMA introduced a telemedicine evaluation and management code family in 2025:

• 98000–98007: Synchronous audio-video services
• 98008–98015: Synchronous audio-only services

Code 98016 describes a separate brief communication technology service. It should not be treated as interchangeable with a full telemedicine E/M visit. American Medical Association

However, the existence of a CPT code does not establish coverage or payment by every payer.

The AMA’s coding handbook explains that CMS did not adopt codes 98000–98015 when the family launched. Instead, Medicare used applicable in-person E/M codes with the required telehealth reporting. Check current Medicare instructions for the service and date rather than assuming another payer’s approach applies. AMA

Before changing a claim template, confirm:

• Which code family the payer accepts
• Whether the documented service meets the code requirements
• Which modifiers and place-of-service instructions apply
• When the policy takes effect

Question to ask: Who verifies a coding change before staff use it on claims?

3. Record the Patient’s Location

The patient’s location helps your team select the appropriate place-of-service code.

For Medicare professional telehealth billing, CMS identifies:

These codes describe where the patient receives care. They do not simply describe where the provider works. CMS

Ask where the patient is at the time of the visit. Then record that information where the provider and billing team can find it.

For example, a patient who usually attends from home may join a later visit from another location. Staff should confirm the location instead of copying it from the previous encounter.

Also, verify each payer’s reporting instructions separately.

Question to ask: How does the patient’s confirmed location reach the claim?

4. Follow the Applicable Modifier Instructions

Modifier requirements depend on the payer, service, code family, and billing setting.

Your reference guide should distinguish audio-video services from audio-only services. It should also explain when the payer requires a modifier and which one applies.

Do not add a modifier simply because another payer accepts that combination. Some codes already describe the visit method, while particular billing arrangements have additional instructions.

CMS guidance, for example, includes different modifier instructions for certain institutional and professional billing circumstances. This is why one modifier rule should not be applied to every telehealth claim. Telehealth & Remote Monitoring

Before submission, compare:

• The documented visit method
• The selected procedure code
• The applicable modifier requirements
• The place-of-service code

If a planned video visit becomes audio only, review the claim setup against what actually occurred.

Question to ask: Who reviews claims when the visit method changes?

5. Make the Documentation Support the Claim

The clinical record should explain the service provided and support the selected code.

It should also make the remote encounter clear.

Depending on the applicable requirements, the record may need to include:

• Whether the visit used video or audio only
• The patient’s location
• The service performed
• Clinical findings and medical necessity
• The elements supporting code selection
• Time, when relevant to the selected code
• Consent or other details required for the arrangement

Your clinical team remains responsible for the accuracy of clinical records.

Billing staff can identify missing information and request clarification. They should not invent findings or add statements about care that did not occur.

Use specific requests. For example, “Please confirm whether this visit used video or audio only” is more useful than “Please add telehealth details.”

Question to ask: How do missing details reach the provider before claim submission?

6. Maintain a Payer-Specific Telehealth Billing Guide

A short reference guide can help staff apply the correct instructions consistently.

For each major payer, include:

• Covered services and visit methods
• Accepted procedure codes
• Modifier requirements
• Place-of-service instructions
• Audio-only conditions
• Authorization or visit limits
• Documentation requirements
• Policy links
• Effective dates and the last review date

Assign someone to maintain the guide.

When a policy changes, update both the reference material and the relevant claim templates. Also, tell staff when the new instructions apply.

For a broader review of billing responsibilities, use our Medical Billing Services Checklist.

Question to ask: Who checks that the guide and claim templates remain consistent?

Review Telehealth Denials Together

Tag telehealth claims in your reports so your team can review patterns.

Useful review fields include:

• Payer and plan
• Procedure code
• Modifier
• Place of service
• Visit method
• Denial reason
• Date of service

Keep clearinghouse rejections separate from payer denials. They occur at different stages and may require different responses.

For each unresolved claim, record the next action, assigned owner, follow-up date, and any relevant deadline.

Then address recurring causes. If several claims lack patient-location information, improve the visit workflow instead of repeatedly researching the location after denial.

Also, review possible payment differences against the applicable contract or payment terms. A paid claim may still need attention.

Measure Whether the Changes Help

Choose a few measures before changing the workflow.

For example, track:

• Telehealth claims rejected before payer processing
• Initial payer denials
• Claims needing code or modifier corrections
• Encounters missing location or visit-method details
• Time spent correcting claims
• Unresolved payment differences

Use consistent definitions and comparable reporting periods.

A lower denial rate can be encouraging. However, changes in payer mix, service volume, or claim types may also affect the result.

Review the figures alongside a sample of accounts to understand what changed.

Get Telehealth Billing Support From CMT

Reliable telehealth billing starts with clear coverage checks, accurate records, and payer-specific claim instructions.

Capitol Medical Technologies helps practices review telehealth claims, investigate denials and payment differences, and identify gaps in billing workflows.

Need help with telehealth billing? Contact CMT to discuss your current process and the claims your team needs support managing.

Website: capitolmedicaltech.com
Email: info@capitolmedicaltech.com
Phone: 571-410-3703