Telehealth & Digital Health Billing

Telehealth and digital health billing have evolved ever since the emergency stopgaps during the pandemic to core components of patient care. Patients value convenience, clinicians appreciate flexibility, and payers are covering more virtual services than ever. But even as telemedicine becomes a permanent part of healthcare delivery, correctly billing these services remains a challenge for many practices.

Accurate telehealth billing requires a deep understanding of CPT/HCPCS codes, place of service (POS) designations, documentation requirements, and payer rules, all of which continue to shift. Without this expertise, practices experience high denial rates, delayed reimbursements, and diminishing revenue margins.

Why Telehealth Billing Is Complex

Telehealth billing is more than just submitting an E/M code with a “video” note. The rapid expansion of telemedicine has introduced new service types and coding nuances:

Different Care Delivery Models: Real-time audio/video visits, e-visits, virtual check-ins, and remote monitoring require distinct coding logic.
Hundreds of Telehealth Codes: more than 100 CPT and HCPCS codes were added as telehealth expanded, and updates continue.
Modifiers and POS Codes Matter: Payers require specific modifiers (e.g., 95 for synchronous telehealth) and accurate POS codes (e.g., 10 for telehealth in patient’s home) and these vary by payer.
Payer Variations: Medicare, Medicaid, and commercial insurers may have different expectations for codes, modifiers, and documentation.

Core Types of Telehealth Encounters

Healthcare providers must know how to classify and code the following:

Real-Time Telehealth Visits: Live, two-way audio/video visits use standard E/M CPT codes (e.g., 99202–99215) but must be paired with the correct modifier and POS to reflect virtual delivery.
Online E-Visits and Virtual Check-Ins: Asynchronous digital communications and brief check-ins have their own CPT/HCPCS codes (e.g., 99421–99423, G2010/G2012) depending on payer rules.
Audio-Only Encounters: Medicare and some commercial payers still recognize audio-only visits in defined circumstances, but they require precise coding and documentation to avoid denials.

Accurate category selection directly impacts whether a claim is paid, downcoded, or denied.

Common Telehealth Billing Errors That Reduce Revenue

Even experienced practices make mistakes, especially when guidelines change frequently. Some of the most frequent issues include:

Wrong Place of Service (POS) Codes: Using the wrong POS (e.g., office code instead of telehealth) can lead payers to treat telehealth claims as in-person visits, triggering denials or reduced payments.
Missing or Incorrect Modifiers:Telehealth claims often require modifiers like 95 (real-time audio/video) or 93 (audio-only), and mistakes here are a leading cause of denials.
Incomplete Documentation: Beyond the code, payers expect documentation that supports the delivery of telehealth, including consent, modality (audio/video), duration, location of provider/patient, and the clinical decision-making recorded clearly.
Misclassifying Telehealth Service Types: Confusion between e-visits, telehealth visits, and virtual check-ins can lead to selecting the wrong code set, and costly errors.

Best Practices for Accurate Telehealth Billing

To prevent revenue loss and denials, telehealth billing should be approached with structured workflows and strong internal controls:

Stay Current on CPT, HCPCS, and Payer Rules

Telehealth codes and payer policies continue to evolve. Regular training and updates help prevent outdated or incorrect coding.

Verify POS and Modifier Requirements Before Submission

Each telehealth encounter must include the correct POS and, if required, the appropriate telehealth modifier. Verify payer-specific rules consistently.

Fully Document Telehealth Sessions

Your clinical note should include:

Patient consent for telehealth.
Modality used (audio/video).
Start and end times.
Clinical decision-making and medical necessity.
Provider and patient locations.

Incomplete charts are a common source of payers challenging claims.

Align Billing and Clinical Teams

Ensure communication between clinicians and billing/coding teams so that clinical intent matches the code(s) billed. Discrepancies often trigger denials.

Audit Telehealth Claims Regularly

Routine internal audits can catch patterns of errors that lead to denials and lost revenue — so they can be corrected proactively.

Why MBNC Telehealth Billing Expertise Matters

Telehealth billing is not static. It is a dynamic intersection of technology, policy, and clinical documentation. Many practices underestimate the administrative burden and compliance complexity, leading to:

Increased denials.
Slower reimbursements.
More time spent on appeals.
Reduced overall revenue.

At MBNC, we specialize in telehealth billing for modern practices. Our services include:

Modifier and POS validation for accurate claims.
Documentation compliance review and chart optimization.
Payer rule tracking across Medicare and commercial insurers.
Regular telehealth billing audits to prevent repeat errors.
Staff training and telehealth coding support.

With MBNC as your billing partner, telehealth revenue becomes predictable, compliant, and maximized, so your practice can focus on patient care.

Telehealth and Digital Health Billing with MBNC

Telehealth and digital health are here to stay, but billing them accurately is a continuous operational challenge. From understanding complex code sets and payer requirements to ensuring documentation captures the full clinical picture, telehealth billing requires precision and ongoing expertise.

If your practice is struggling with telehealth billing complexity, you’re not alone, and you don’t have to navigate it alone either. MBNC specializes in turning telehealth coding and billing confusion into clarity, consistency, and revenue.

Let MBNC optimize your telehealth billing, so you get paid for the care you deliver.