Telehealth Billing Services by Prospect Healthcare Solutions
Telehealth billing services cover the coding, claims, denials and payments for virtual care: video visits, audio-only sessions, virtual check-ins and remote monitoring. Prospect Healthcare Solutions handles this full revenue cycle for mental health practices, primary care clinics and specialists who see patients online, so your team can focus on care instead of payer rules.
Virtual visits are easy for patients and hard to bill. Each payer sets its own place-of-service codes, modifiers, audio-only limits and documentation rules, and those rules keep changing. We code every visit from the note, apply the payer’s current telehealth policy and follow each claim until it is paid.
Prefer to talk? Call +1 (469) 935-4617.
Why Telehealth Billing Needs Special Expertise
A telehealth claim can be clinically perfect and still be denied because of one wrong code. The patient’s location decides the place of service, the technology used decides the modifier, and the payer decides whether the service is covered virtually at all. Medicare, Medicaid programs and commercial plans each handle these differently.
Common challenges include:
- Choosing POS 02 or POS 10 based on where the patient was
- Modifier 95, 93, GT or FQ rules that differ by payer
- Audio-only coverage limits
- Consent, patient location and time missing from the note
- Provider licensure in the patient’s state
- Policies that change with federal extensions and payer updates
Telehealth Payer Rules We Manage
These are the telehealth-specific rules our revenue cycle management team checks on every virtual claim:
Place of service: POS 02 vs POS 10
What it means: Medicare uses POS 10 when the patient is at home and POS 02 when the patient is somewhere else, such as a clinic. Home visits under POS 10 are paid at the higher non-facility rate.
How we handle it: We confirm the patient’s location from the note and set the POS each payer expects before the claim goes out.
Telehealth modifiers
What it means: Modifier 95 marks a real-time audio-video visit, 93 an audio-only visit, and FQ an audio-only service at an RHC or FQHC. Some Medicaid and commercial plans still ask for GT.
How we handle it: We keep a payer-by-payer modifier map and update it when policies change.
Medicare flexibilities through 2027
What it means: The Consolidated Appropriations Act, 2026 extended Medicare telehealth flexibilities through December 31, 2027, so patients can be seen at home and in any U.S. location, regardless of rural status.
How we handle it: We track the end date and payer updates so your Medicare telehealth claims stay billable.
Behavioral health in-person rule
What it means: Home-based mental health telehealth is permanent under Medicare. From January 1, 2028, most patients will need an in-person visit within six months before starting, then yearly. Patients who start telehealth by December 31, 2027 only need the yearly visit.
How we handle it: We flag patients who will need in-person visits before the rule takes effect.
Audio-only visits
What it means: Audio-only care is covered for behavioral health and some other services, but many payers limit it. The note must show why video was not used when the payer requires it.
How we handle it: We check audio-only coverage for each payer and confirm the note supports the modifier we apply.
Commercial, Medicaid and state rules
What it means: Commercial plans and state Medicaid programs set their own telehealth coverage, payment parity and consent rules, and the provider must be licensed in the patient’s state.
How we handle it: We verify telehealth benefits at eligibility and check licensure and credentialing before billing.
Our Complete Telehealth Billing Services
We manage the full virtual care revenue cycle, from eligibility checks to final payment.
1. Insurance Eligibility and Telehealth Benefits
Before each appointment we confirm coverage, telehealth benefits, copays, deductibles and any authorization requirements, so patients know what they owe and claims are not rejected for eligibility.
2. Telehealth Coding and Documentation Review
Certified coders assign CPT, HCPCS and ICD-10-CM codes, the correct place of service and the right modifier for each payer. We also check that the note records consent, patient location, technology used and time where required. See our medical coding services.
3. Clean Claim Submission
Claims are scrubbed against payer telehealth edits before submission to Medicare, Medicaid and commercial plans, then tracked until paid, with rejections corrected the same day.
4. Denial Management and Appeals
Every telehealth denial is worked through a structured process:
- Root cause analysis (POS, modifier, coverage or documentation)
- Corrected claims
- Appeals supported by the visit note and payer policy
See our denial management services.
5. Payment Posting and Patient Billing
We post and reconcile payments, flag underpayments against your contracted telehealth rates, and handle patient statements and billing questions.
Common Telehealth Denials and How We Fix Them
Example: a home video visit billed with the wrong place of service
The denial. A video follow-up with a patient at home is billed with POS 11 (office) and no telehealth modifier. The payer denies it with CARC 4 (modifier inconsistent or missing) or pays it as an in-person visit, which creates audit risk.
How we fix it:
- Check the note. We confirm the patient was at home and the visit used real-time audio and video.
- Correct the claim. We resubmit with POS 10 and the modifier that payer requires.
- Fix the template. We update the scheduling or charge setup so telehealth visits never default to POS 11.
Learn more in our guide to POS 11 in medical billing.
Example: an audio-only therapy session denied as non-covered
The denial. A 45-minute psychotherapy session (90834) held by phone is billed without modifier 93, and the payer denies it because the service is not covered as billed.
How we fix it:
- Confirm coverage. We check the payer’s audio-only policy for behavioral health.
- Check the documentation. The note must show time, consent and why video was not used.
- Resubmit. We add modifier 93 and the correct POS and send the corrected claim.
- Prevent the next one. Audio-only visits are tagged at scheduling so they are coded correctly first time.
Telehealth Billing for Every Specialty
Mental and Behavioral Health
We bill virtual therapy, psychiatric evaluations and medication management, including psychotherapy time codes and add-ons. See our mental health billing services.
Primary Care and Family Practice
We code virtual E/M visits for acute problems, chronic condition follow-up and medication reviews by medical decision making or time. See our family practice billing.
Specialty Care and Remote Monitoring
We bill virtual consults for neurology, endocrinology, dermatology and other specialties, plus remote patient monitoring. Read our guide to RPM CPT codes.
Telehealth CPT Codes, POS Codes and Modifiers
These are the telehealth codes and modifiers we work with most. Coverage and modifier rules vary by payer, so we confirm each one before billing.
| Service | Codes | What we check |
|---|---|---|
| Office and outpatient E/M by video | 99202–99205, 99211–99215 | Level supported by MDM or time; POS and modifier per payer |
| Psychiatric evaluation | 90791, 90792 | Medical services documented for 90792 |
| Psychotherapy | 90832, 90834, 90837 (+90833, 90836, 90838 with E/M) | Session time; audio-only rules |
| Online digital E/M (patient portal) | 99421–99423 | Cumulative time over 7 days; patient-initiated |
| Remote patient monitoring | 99453, 99454, 99457, 99458 | Device days and management time |
| Place of service | POS 02 (not at home), POS 10 (at home) | Patient location documented |
| Telehealth modifiers | 95, 93, GT, FQ | Technology used and payer requirement |
For time rules on therapy codes, see psychotherapy CPT codes 90832, 90834 and 90837.
Why Outsource Telehealth Billing Services?
Keeping up with telehealth rules in-house means constant training and policy tracking, and one missed update can affect every virtual claim. Outsourcing to Prospect Healthcare Solutions gives you:
- Lower operating costs
- Fewer POS and modifier errors
- Faster reimbursement
- Higher collections
- Stronger compliance
Built for Growing Virtual Practices
- Dedicated telehealth billers
- Certified coders and billers
- HIPAA-compliant processes
- Regular audits and quality checks
- Workflows customized to your practice and EHR
Telehealth Billing Compliance
Telehealth is closely watched by payers and auditors. We follow CMS, HIPAA and payer rules to reduce your audit risk, and build compliance into every step:
- Correct POS and modifier use
- Patient consent and location documented
- Audio-only use supported by the note
- Provider licensure in the patient’s state
- Medical necessity documented for every visit
Learn about our medical billing audits.
Who We Serve
Our telehealth billing services support solo providers, group practices and virtual-first organizations:
- Psychiatrists, psychologists and therapists
- Primary care and family practice clinics
- Specialists offering virtual consults
- Nurse practitioners and physician assistants
- Remote patient monitoring programs
- Virtual-first and hybrid care practices
Technology and Reporting for Telehealth Billing
We work in your EHR and practice management system and use billing analytics to catch problems early:
- Real-time claim tracking
- Telehealth denial trends by payer
- Virtual vs in-person revenue reporting
- Secure, HIPAA-compliant data handling
Clear reports show what each payer pays for virtual care, so you can decide where telehealth makes sense for your practice.
Telehealth Billing Services FAQs
What are telehealth billing services?
They cover eligibility checks, coding, claim submission, denial management and payment posting for virtual care, including video visits, audio-only sessions, online digital visits and remote patient monitoring.
What is the difference between POS 02 and POS 10?
POS 10 is used when the patient is in their home during the telehealth visit, and POS 02 when the patient is somewhere other than home. Medicare pays POS 10 at the non-facility rate and POS 02 at the facility rate.
When do I use modifier 95, 93 or GT?
Modifier 95 shows a real-time audio-video visit and 93 an audio-only visit. GT is an older telehealth modifier that some Medicaid and commercial plans still require. The right choice depends on the payer, so we check each policy.
Can Medicare patients get telehealth at home in 2026?
Yes. The Consolidated Appropriations Act, 2026 extended Medicare telehealth flexibilities through December 31, 2027, so patients can receive covered telehealth at home. Home-based behavioral health telehealth is permanent.
Do you bill telehealth mental health services?
Yes. We bill virtual psychotherapy, psychiatric evaluations and medication management, including audio-only sessions where the payer allows them, with the right POS, modifier and time documentation.
How do I get a quote for telehealth billing?
Request a free billing quote online or call +1 (469) 935-4617. We review your current telehealth billing and send a plan and pricing.
Partner with Experts in Telehealth Billing Services
Virtual care should grow your practice, not your billing backlog. We handle your telehealth coding, claims, denials and compliance so you get paid accurately and on time for every visit.
Tell us about your practice for a free quote, or call +1 (469) 935-4617.