Medical Billing Terms T: Telehealth Codes, Modifier 95 and Taxonomy Codes

Telehealth codes and modifiers tell a payer that a visit was delivered by video or audio. This page defines them with the terms from T1017 to tertiary insurance, including modifier 95, taxonomy code, TIN, TennCare and telepsychiatry. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms T: Telehealth Codes - MCM South Medical Billing Service, LLC

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On this page (16 terms)

T1017
Takeback
Targeted Case Management (TCM)
Targeted Probe and Educate (TPE)
Tax Identification Number (TIN)
Taxonomy Code
Tebra
TEFCA
Telehealth
Telehealth Flexibilities
Telehealth Licensure
Telehealth Modifier 95
Telehealth Platform
Telepsychiatry
TennCare
Tertiary Insurance

How to use these Telehealth Codes definitions

Use this page as a quick reference for Telehealth Codes, from T1017 to Tertiary Insurance. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Telehealth Codes details with the payer before you bill.

Checklist: put the telehealth codes definitions to work

T1017: Unverified for in-home use; state policy decides coverage.
Takeback: Takebacks create surprise negative balances and may allow limited appeal windows.
Targeted Case Management (TCM): Coverage, provider rules, and codes vary by state. It is often used for people with serious mental illness.
Targeted Probe and Educate (TPE): Poor results can escalate to other actions.

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T1017

General (all payers)

Also called T1017 code

Definition: A HCPCS code for targeted case management, per 15 minutes, used by some state programs.
Why it matters: Unverified for in-home use; state policy decides coverage.
Illustrative example: A state lists T1017 for targeted case management.

Related termsMedicaid HCPCS Code H2017

Reference sourceCMS HCPCSchecked 10/9/26

CategoriesMedicare & Medicaid Terms Behavioral Health Specific Terms

Takeback

General (all payers)

Also called payer takeback; retro takeback; retroactive denial

Definition: A payer's reversal of a previously paid claim, often after a later review or eligibility finding, followed by recovery of the money.
Why it matters: Takebacks create surprise negative balances and may allow limited appeal windows.
Illustrative example: A payer retroactively denies a paid claim because coverage was terminated.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement Denials & Appeals

Targeted Case Management (TCM)

Medicaid (state-specific)

Also called TCM; Medicaid case management; targeted case management

Definition: Targeted case management is a Medicaid service that helps a defined group of people get medical, social, and other services. States can choose which groups to cover.
Why it matters: Coverage, provider rules, and codes vary by state. It is often used for people with serious mental illness.
Illustrative example: A clinic bills targeted case management for a patient who needs help linking to housing and treatment.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms Medicare & Medicaid Terms

Targeted Probe and Educate (TPE)

General (all payers)

Also called TPE; Medicare TPE review

Definition: A Medicare review approach where a contractor reviews a sample of a provider's claims and offers education, with repeated rounds if error rates remain high.
Why it matters: Poor results can escalate to other actions.
Illustrative example: A MAC starts TPE for a specific code.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance Medicare & Medicaid Terms

Tax Identification Number (TIN)

General (all payers)

Also called TIN; EIN; tax ID

Definition: The number the IRS assigns to a billing entity; payers use it to issue payment and 1099 forms. It appears on claims as the billing provider's tax ID.
Why it matters: A TIN mismatch between the claim, the contract, and the payer enrollment can hold or misdirect payment.
Illustrative example: A practice changes its legal entity and must update its TIN with every payer.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesProvider Data Management Terms Payment & Reimbursement

Taxonomy Code

General (all payers)

Also called provider taxonomy; healthcare provider taxonomy code; NUCC taxonomy

Definition: A 10-character code from the NUCC Health Care Provider Taxonomy code set that describes a provider's type and specialty.
Why it matters: Some payers edit claims against the taxonomy on file; a mismatch can reject or deny claims.
Illustrative example: A psychologist's NPPES record lists a psychologist taxonomy that matches what the payer has on file.

Reference sourceNUCCchecked 10/9/26

CategoriesProvider Data Management Terms EDI & Clearinghouse Terms

Tebra

General (all payers)

Also called Kareo; Tebra practice management

Definition: A vendor of practice management, EHR, and patient engagement software; the Kareo brand transitioned to Tebra. Listed for reference; not an endorsement or partnership.
Why it matters: Legacy Kareo name still appears in older workflows.
Illustrative example: A practice uses Tebra for claims.

Reference sourceTebrachecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

TEFCA

General (all payers)

Also called Trusted Exchange Framework and Common Agreement

Definition: A federal framework meant to enable nationwide health information exchange among networks.
Why it matters: Emerging channel for exchanging records.
Illustrative example: A network participates in TEFCA exchange.

Related termsInteroperability HL7

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Telehealth

General (all payers)

Also called telemedicine; virtual care; teletherapy; telebehavioral health

Definition: Delivery of health care services using real-time audio and video or other technology when the patient and clinician are in different places.
Why it matters: Coverage, codes, modifiers, and licensure rules vary by payer and state.
Illustrative example: A therapist sees a patient by video from the therapist's office.

Reference sourceHHS (U.S. Department of Health and Human Services)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesTelehealth Terms

Telehealth Flexibilities

General (all payers)

Also called Medicare telehealth waivers; telehealth extensions

Definition: Temporary or extended changes to Medicare telehealth rules, often set by Congress or CMS for defined periods.
Why it matters: Expiration dates affect billing rules and must be confirmed.
Illustrative example: A flexibility applies through a stated date unless extended.

Related termsOriginating Site Telehealth

Reference sourceCMS (Centers for Medicare & Medicaid Services)HHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesTelehealth Terms Medicare & Medicaid Terms

Telehealth Licensure

General (all payers)

Also called out-of-state telehealth; patient location licensure

Definition: The rule that generally requires a clinician to be licensed in the state where the patient is located when care is delivered.
Why it matters: Determines which patients a therapist can see by telehealth.
Illustrative example: A therapist licensed in one state cannot treat a patient located in another without authority.

Related termsLicensure Compact State License

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesTelehealth Terms Credentialing & Enrollment

Telehealth Modifier 95

General (all payers)

Also called modifier 95; synchronous telemedicine modifier

Definition: A modifier indicating a service delivered through real-time, interactive audio and video telecommunications.
Why it matters: Many payers require it or an equivalent POS; requirements differ.
Illustrative example: A therapist appends modifier 95 to 90834 for a video session where required.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesTelehealth Terms Claims Processing

Telehealth Platform

General (all payers)

Also called video visit software; HIPAA-compliant video

Definition: Software used to deliver video sessions, which for covered entities should be configured to meet HIPAA requirements and be covered by a business associate agreement where required.
Why it matters: Security and vendor agreements matter for compliance.
Illustrative example: A practice uses a video platform under a BAA.

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms Telehealth Terms

Telepsychiatry

General (all payers)

Also called telepsychiatry; tele-psychiatry; psychiatric telehealth

Definition: Telepsychiatry is psychiatric care, such as evaluation and medication management, delivered through telehealth.
Why it matters: Billing follows the same E/M and psychotherapy codes with telehealth modifiers and place of service. Prescribing controlled substances by telehealth has its own federal and state rules.
Illustrative example: A psychiatrist bills 99214 with modifier 95 and the payer's telehealth place of service for a video medication visit.

Reference sourceAmerican Psychiatric Association CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesTelehealth Terms Behavioral Health Specific Terms

TennCare

Medicaid (state-specific)

Also called Tennessee Medicaid

Definition: The name of Tennessee's Medicaid program, which uses managed care organizations.
Why it matters: Tennessee is a served state; its plans and rules are separate from others.
Illustrative example: A Tennessee provider contracts with TennCare MCOs.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms

Tertiary Insurance

General (all payers)

Also called tertiary payer; third payer

Definition: The third plan in order when a patient has three coverages.
Why it matters: Rare but requires the same sequencing discipline.
Illustrative example: A patient has employer, spouse, and Medicaid coverage.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEligibility & Benefits Claims Processing

Quick answer: Telehealth Codes

What are telehealth codes in billing?

Delivery of health care services using real-time audio and video or other technology when the patient and clinician are in different places. Coverage, codes, modifiers, and licensure rules vary by payer and state.

Frequently asked questions: Telehealth Codes

What is telehealth modifier 95?

Telehealth Modifier 95 is a modifier indicating a service delivered through real-time, interactive audio and video telecommunications. Many payers require it or an equivalent POS; requirements differ.

What is a taxonomy code?

A 10-character code from the NUCC Health Care Provider Taxonomy code set that describes a provider's type and specialty. Some payers edit claims against the taxonomy on file; a mismatch can reject or deny claims.

What is a TIN in billing?

Tax Identification Number (TIN) is the number the IRS assigns to a billing entity; payers use it to issue payment and 1099 forms. It appears on claims as the billing provider's tax ID. A TIN mismatch between the claim, the contract, and the payer enrollment can hold or misdirect payment.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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