Telehealth moved from a niche billing topic to a routine one, and the coding rules went through a major change in 2025 that is still settling out. The principles below are durable, but telehealth is the single fastest-moving area in coding, so every specific code and modifier here must be confirmed against current payer guidance before you rely on it. This chapter gives you the structure and the current state, not a promise that the details will hold.
The Core Idea: Telehealth Visits Code Like Office Visits
For most covered telehealth visits, you select the level the same way you would in person: by medical decision making or by total time. The cognitive work is identical, and the MDM table you learned earlier applies without modification. What differs is not the level selection but the surrounding administrative layer: which code set to use, which modifier identifies the visit as virtual, and which place-of-service code says where the patient was. Get the level right the usual way, then dress the claim correctly for telehealth.
The 2025 Split: New Codes, but Not for Medicare
In 2025, CPT introduced a dedicated family of telemedicine codes: 98000 through 98007 for audio-video visits and 98008 through 98015 for audio-only, each selected by MDM or total time, with defined time thresholds at each level. For these codes, modifier 95 is not required, because the code descriptor already says the visit was virtual.
Here is the catch that makes this complicated in practice. Medicare announced it will not accept the new 98000 through 98015 codes. For Medicare telehealth, you continue to report the standard office E/M codes (99202 through 99215), append modifier 95 for audio-video or modifier 93 for audio-only, and use the correct place-of-service code. So in the same week you may code the same telehealth visit two different ways depending on the payer: the new dedicated codes for a commercial plan that accepts them, and the old office-code-plus-modifier approach for Medicare. This is the central source of telehealth coding errors right now, and it is why verifying each payer's stance is not optional.
Place of Service Is Not a Formality
The place-of-service code tells the payer where the patient was located, and getting it wrong causes underpayment or denial even when the CPT code is correct. The two telehealth codes that matter: place of service 10 when the patient is at home, and place of service 02 when the patient is somewhere other than home. During the pandemic many payers let you keep place of service 11 (office) so the visit paid at the full in-office rate, but that allowance has been narrowing. The documentation should state where the patient physically was at the time of the visit, because that is what the place-of-service code has to match.
Audio-Only Has an Extra Requirement
Audio-only visits, the telephone calls where video was not used, are payable in more circumstances than they once were, but they carry a specific documentation requirement: the encounter must include more than 10 minutes of medical discussion with the patient, whether you select the level by MDM or by time. A visit under five minutes is not separately reportable at all. If you use audio-only, the note should record that video was not used, ideally why, and the time spent in discussion. There is also a brief check-in code (98016) for established patients for short five-to-ten-minute synchronous contacts, which replaced the older Medicare check-in code.
Coding Telehealth by Time
When you select a telehealth level by total time, count the same activities you would for an in-person time-based visit on the date of service: reviewing records and results, the visit itself, documenting, ordering, and coordinating care. Do not count travel, separately reported services, or general teaching. For visits that run long, the prolonged-services add-on (99417) applies in the same way it does in the office, in increments beyond the highest level's time threshold.
The Documentation That Protects a Telehealth Visit
Whatever the year's specific code set, a defensible telehealth note records four things: the modality (audio-video, or audio-only and why), the patient's location at the time of the visit, the patient's consent to a telehealth encounter where your payer requires it, and the same clinical substance any visit needs to support its level. If you code by time, document the total time. The principle is unchanged from the in-person world: the note has to tell the system what kind of visit happened, where, and what work it involved. The codes and modifiers will keep changing; a complete note is what survives the changes.
Sources and Further Reading for This Chapter
- CMS, Physician Fee Schedule. https://www.cms.gov/medicare/payment/fee-schedules/physician