Telehealth Billing for Therapists: 5 Checks Before You Submit Claims
Telehealth billing for therapists depends on three things: the place of service code, the modifier and the payer’s own rules. Telehealth policy has changed often, so a claim that paid last year may deny today. These five checks help you submit telehealth claims the way each payer expects.
How telehealth billing for therapists works
A telehealth claim uses the same procedure codes as an in-person visit, such as the psychotherapy codes in the CPT and E/M code guide. What changes is how you show that the visit was remote: the place of service, sometimes a modifier, and your documentation. Each payer decides which codes and which settings it will pay.
5 critical checks for telehealth billing for therapists
1. Use the right place of service
Medicare uses POS 02 for telehealth provided somewhere other than the patient’s home and POS 10 for telehealth provided in the patient’s home. CMS describes this in its telehealth FAQ.
2. Ask each payer about modifiers
Many commercial payers want a modifier such as 95 for video or 93 for audio-only. Some do not. Do not copy one payer’s modifier onto another payer’s claims.
3. Confirm the visit type is covered
Check whether the payer covers video, audio-only or both for your service.
4. Document location and technology
Note that the visit was remote, the technology used and where the client and clinician were located. See documentation requirements.
5. Confirm licensure for the client’s state
Many states require a license where the client is located. Check before you see a client across state lines.
Private payers vs Medicare vs Medicaid
Medicare
CMS says telehealth for mental health has no geographic restriction and the patient’s home can be the originating site. The CMS FAQ also says the in-person visit requirement for home-based mental health telehealth applies after December 31, 2027, and that other flexibilities run through that date. Rules change, so read the current CMS telehealth page. See Medicare behavioral health billing.
Private payers
Policies vary by company and plan. Review telehealth billing rules by payer and read each provider manual.
Medicaid
Each state sets telehealth rules for Medicaid and managed care plans. They vary by state. Start with the state billing guides, state telehealth parity laws and originating site rules.
Common telehealth billing errors
The most frequent mistakes are the wrong place of service, a missing modifier, an unsupported audio-only claim and billing from a state where you are not licensed. A denial for any of these can usually be fixed, but only if you catch it in time. See claims denied or rejected by insurance and timely filing for therapists.
Keep your policy list current
Telehealth rules change on payer and government schedules. Keep a one-page list for each payer and review it every quarter. If this feels like too much to track, read signs it is time to outsource billing.
Consistent telehealth billing for therapists starts with a simple habit: check each payer’s policy before you add a new service or state. Good telehealth billing for therapists also means training anyone who enters claims, so the place of service and modifier are never guessed. Review denials by reason each month to spot patterns early.
Key takeaways
Right place of service, right modifier, covered visit type, clear documentation and proper licensure. Check each payer’s current policy before you submit.
Frequently asked questions
What place of service code do I use for telehealth from the client’s home?
Medicare uses POS 10 for telehealth in the patient’s home. Other payers may differ, so confirm each policy.
Do I always need modifier 95?
No. Some commercial payers require it and some do not. Check each payer.
Does audio-only count as telehealth?
It depends on the payer and the service. Medicare allows audio-only for certain mental health services when the patient is at home.
Where can I confirm Medicare’s current telehealth rules?
Use the CMS telehealth page and the CMS telehealth FAQ, which are updated as policy changes.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.
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