What Telehealth Billing Involves
Telehealth is not a separate service line so much as a different set of rules layered over services you already bill, and the rules change by payer, by state and by year. A visit that was payable last quarter can be denied this one because a flexibility lapsed rather than because anything about the care changed.
The four things that decide whether a telehealth claim is paid are the place of service code, the modifier (95, GT, GQ or FQ depending on payer and modality), whether the encounter was audio-video or audio-only, and whether the patient's location is one the plan recognises. Get the first two wrong together and the claim pays at the wrong rate rather than denying outright, which is worse - it looks fine until an audit.
State law adds a second layer. Payment parity, coverage parity and cross-state licensure all vary, and a provider treating patients in a state they are not licensed in has a compliance problem, not a billing one.
We keep current payer policy per plan rather than a single house rule, code from the documented modality, and check patient location against plan policy before the claim goes out. Where a provider works across state lines we flag the licensure and enrollment gaps before they become recoupments.
Behavioral health carries the most telehealth volume - see mental health billing and credentialing - and enrollment is covered on telehealth credentialing services.
