- Bidisha Gupta
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Telehealth claims fail for small reasons. A visit is clinically sound, yet the claim carries the wrong place of service or a missing modifier. Then the payer denies it, and someone has to work it twice. Telehealth CPT codes have also changed sharply since 2025. So billing teams need a current map.
This guide maps telehealth CPT codes for 2026. It covers the codes, the place of service rules, the modifiers, and the Medicare policies behind them. Every rule links to its source, because payer policies differ and change. Treat it as orientation, and confirm specifics against the current CPT code set and each payer’s policy.
How Telehealth CPT Codes Work in 2026
A telehealth claim rests on three parts. The CPT or HCPCS code says what service the clinician delivered. The place of service code says where the patient was. The modifier says how the visit happened, such as video or audio only. A claim pays cleanly only when all three agree with the payer’s rules.
The rules for telehealth CPT codes are not uniform. The American Medical Association maintains the CPT code set, but each payer decides which codes it accepts. Medicare publishes its own list of telehealth services and updates it every January. Commercial plans and Medicaid programs then set separate policies. Therefore, the same visit can need different coding for different payers.
That variation is why support work matters before the claim exists. Scheduling teams capture the patient’s location, the visit type, and consent at booking. Our telehealth support services handle that front-end work, so the billing team starts with clean data.
The Telehealth CPT Codes Billing Teams Use Most
Most telehealth volume falls into a handful of code families. The table below groups them and notes how Medicare treats each one. Always check the current descriptor before you bill, because time thresholds differ by code.
| Code family | Codes | What they describe | Medicare note |
|---|---|---|---|
| Office and outpatient visits | 99202-99215 | New and established patient visits, selected by time or medical decision-making | Billed for telehealth with place of service 02 or 10 |
| Telemedicine visits, audio-video | 98000-98007 | Synchronous audio-video visits for new and established patients | Not recognized by Medicare |
| Telemedicine visits, audio-only | 98008-98015 | Synchronous audio-only visits that include a medical discussion | Not recognized by Medicare |
| Brief virtual check-in | 98016 | One medical discussion of five to ten minutes, unrelated to a recent or upcoming visit | Confirm payment in the current fee schedule |
| Online digital visits | 99421-99423 | Patient-initiated portal communication over seven days, by cumulative time | Confirm coverage with each payer |
| Remote evaluation of an image | G2010 | Review of a video or image the patient recorded, with follow-up | Confirm coverage with each payer |
Medicare’s list covers far more than these families. It held more than 250 codes at the start of 2025, according to HHS. For 2026, CMS added services including multiple-family group psychotherapy and group behavioral counseling for obesity. So check the list itself before you assume a service qualifies.
Why Payers Split on CPT Codes 98000-98015
The AMA introduced 17 telemedicine codes in the 2025 code set. According to the AMA, codes 98000 to 98007 cover audio-video visits, and 98008 to 98015 cover audio-only visits. Clinicians select them by medical decision-making or total time. However, Medicare did not adopt them.
Medicare contractor guidance is explicit on this point. Noridian states that Medicare does not recognize codes 98000 to 98015. Under the 2025 fee schedule, they carry status indicator I, meaning invalid. Instead, practices bill Medicare the standard office visit codes with a telehealth place of service. We found no CMS notice reversing that for 2026, but confirm it in the current fee schedule. Other payers vary, so check each plan’s policy before you choose a code family.
Telephone Codes 99441-99443 No Longer Exist
The telephone visit codes are gone. The AMA deleted codes 99441 to 99443 when it created the new telemedicine set. As a result, claims that still carry them will be rejected. For Medicare, an audio-only visit now uses the office visit code with modifier 93. For other payers, the audio-only codes 98008 to 98015 may apply. Update charge masters and templates, because old favorites lists often keep deleted codes alive.
Place of Service Codes for Telehealth
Place of service causes frequent confusion. Two codes apply to telehealth, and they pay differently under Medicare. The difference depends on where the patient sits during the visit, not where the clinician sits.
| Code | Definition | Medicare payment |
|---|---|---|
| POS 02 | Telehealth provided other than in the patient’s home | Facility rate |
| POS 10 | Telehealth provided in the patient’s home | Non-facility rate |
CMS defines the home as a private residence, not a hospital or other facility. Since January 1, 2024, Medicare has paid home telehealth claims at the non-facility rate. Its claims manual lists POS 02 among facility-rate settings and POS 10 among non-facility settings. Consequently, the wrong code changes the payment, not just the paperwork. Capture the patient’s location at scheduling, and confirm it at the start of the visit.
Telehealth Modifiers and When to Use Each
Modifiers tell the payer how the service reached the patient. Medicare uses fewer of them than many billing teams expect. Other payers set their own requirements, so keep a payer-specific grid.
| Modifier | Meaning | Where Medicare guidance applies it |
|---|---|---|
| 93 | Synchronous audio-only service | Audio-only telehealth claims |
| FQ | Audio-only service, Medicare modifier | Rural health clinics and federally qualified health centers |
| 95 | Synchronous audio-video service | Outpatient therapy by hospital-employed therapists |
| GT | Interactive audio-video | Critical access hospital Method II institutional claims |
| GQ | Asynchronous store-and-forward | Federal telemedicine demonstrations in Alaska and Hawaii |
Audio-only deserves extra care. Since January 1, 2025, Medicare allows audio-only telehealth when the patient is at home and cannot use video. The same applies when the patient does not consent to video. The clinician must still be capable of video. According to HHS, practices then append modifier 93, or FQ for rural health clinics and health centers. Document the reason for audio-only in the record, because the modifier attests to it.
Modifier 95 causes a lot of rework. CMS guidance limits its Medicare use to outpatient therapy by hospital-employed therapists. Other payers set their own rules for it, and some require it on video visits. So never copy one payer’s modifier rule to another.
Medicare Telehealth Rules That Affect Coding in 2026
Coding follows coverage, so the policy calendar matters. Congress extended the main Medicare telehealth flexibilities again in early 2026. According to HHS, patients can receive non-behavioral telehealth at home through December 31, 2027. Geographic limits on the originating site stay lifted until the same date. Audio-only delivery for those services also continues until then.
Behavioral health works differently. Home access, audio-only delivery, and the removal of geographic limits are permanent for behavioral and mental health telehealth. The in-person visit requirement remains on hold through December 31, 2027. CMS explains in its telehealth FAQ that the requirement applies after that date. Rural health clinics and health centers can also keep billing non-behavioral telehealth with HCPCS code G2025 through 2027.
The 2026 fee schedule changed several details too. CMS removed frequency limits for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations. It also made virtual direct supervision permanent, through real-time audio and video. For the originating site facility fee, code Q3014, Medicare pays 80% of the lesser of the charge or $31.85. Unless Congress acts again, the older restrictions return on January 1, 2028.
Remote Patient Monitoring CPT Codes
Remote monitoring sits beside telehealth, but it follows separate rules. The codes pay for device supply and for management time, not for a visit. For 2026, the AMA added codes for shorter monitoring periods, covering 2 to 15 days of data. It also added management codes that require only 10 minutes a month.
| Code | What it covers |
|---|---|
| 99453 | Initial device setup and patient education |
| 99454 | Device supply with data on 16 or more days in a 30-day period |
| 99445 | Device supply with data on 2 to 15 days in a 30-day period (new for 2026) |
| 99457 | Treatment management, first 20 minutes in a calendar month |
| 99470 | Treatment management, first 10 minutes in a calendar month (new for 2026) |
| 99458 | Each additional 20 minutes of treatment management |
CMS sets guardrails that billing teams should build into edits. Its remote monitoring guidance ties each supply code to a day count. Data must cover 2 to 15 days, or 16 or more. Only one practitioner can bill remote monitoring for a patient in a 30-day period. In addition, you cannot bill remote physiologic monitoring and remote therapeutic monitoring together. Track the day count automatically, because manual counts fail at scale.
Where Telehealth Claims Get Denied
Many telehealth denials trace back to a mismatch, not a clinical dispute. Federal data shows the wider pattern. In 2024, administrative reasons drove 25% of in-network claim denials on HealthCare.gov plans. Telehealth adds more ways for the administrative details to go wrong.
Five errors are worth building edits for. First, the place of service does not match the patient’s actual location. Second, a team bills codes 98000 to 98015 to a payer that rejects them. Third, an audio-only visit goes out without the audio-only modifier. Fourth, the service is not on the payer’s telehealth list. Finally, a remote monitoring claim misses its day threshold.
Upstream steps prevent many of these. Accurate insurance verification confirms telehealth benefits before the visit. Timely prior authorization stops avoidable denials for services that need approval. Our article on the CMS prior authorization rule explains the new decision deadlines. Then our claims processing team applies payer-specific edits before submission.
A Pre-Submission Checklist for Telehealth Claims
A short checklist catches many errors before they cost a resubmission. Run it for every telehealth claim until you automate the edits. The table below pairs each check with the reason it matters.
| Check | Why it matters |
|---|---|
| Patient location recorded at the visit | Decides POS 02 or POS 10, and the payment rate |
| Visit modality documented | Decides whether an audio-only or video modifier applies |
| Code family matched to the payer | Medicare does not recognize 98000-98015; other payers differ |
| Service confirmed on the payer’s telehealth list | Off-list services deny regardless of coding |
| Time or medical decision-making documented | Supports the visit level selected |
| Reason for audio-only noted | The modifier attests to it |
| Monitoring day count confirmed | Decides between the 2 to 15 day code and the 16 day code |
Assign one owner for the payer grid, and review it each January. That is when Medicare updates its telehealth list and fee schedule. Mid-year changes also happen, as the 2026 extension showed.
Stop losing telehealth revenue to preventable denials
Our bilingual teams capture patient location, modality, and consent at scheduling, then check every telehealth claim against payer rules. Share your denial report, and we will show you where the leaks are.
Conclusion
Getting telehealth CPT codes right in 2026 comes down to agreement between three fields. The code, the place of service, and the modifier must match each other and the payer’s policy. Practices still bill Medicare with standard office visit codes. Medicare pays by patient location and uses modifier 93 for audio-only visits. Meanwhile, its main flexibilities now run through December 31, 2027.
So build the rules into your workflow, not your memory. Capture location and modality at scheduling, keep a payer grid, and automate the edits. If your team lacks the capacity, our revenue cycle management and appointment scheduling teams can carry both ends. This guide is informational, so confirm each rule against current payer policy before you bill.
Frequently Asked Questions
What CPT codes are used for telehealth?
The most common telehealth CPT codes are office and outpatient codes 99202 to 99215. The CPT code set also includes telemedicine codes 98000 to 98015 and the brief check-in code 98016. Online digital visits use 99421 to 99423. However, payers accept different code families. Therefore, check the payer’s telehealth policy before you choose.
Does Medicare pay for CPT codes 98000-98015?
No, based on the contractor guidance available. Medicare does not recognize codes 98000 to 98015, and its 2025 fee schedule lists them as invalid. Instead, bill Medicare the standard office visit code with place of service 02 or 10. Then confirm the status in the current fee schedule, because CMS can change it.
What is the difference between POS 02 and POS 10?
POS 10 means the patient received telehealth at home. POS 02 means the patient was somewhere other than home, such as a clinic. Medicare pays POS 10 claims at the non-facility rate and POS 02 claims at the facility rate. So the patient’s location directly affects payment.
Which modifier is used for audio-only telehealth?
Modifier 93 identifies a synchronous audio-only service. HHS guidance pairs it with Medicare audio-only telehealth claims. Rural health clinics and federally qualified health centers use Medicare modifier FQ instead. In each case, document why the visit was audio-only.
Are Medicare telehealth flexibilities still in place in 2026?
Yes. According to HHS, the main flexibilities for non-behavioral telehealth run through December 31, 2027. They include home as an originating site, no geographic limits, and audio-only delivery. Several behavioral health flexibilities are permanent. Unless Congress extends them again, the older limits return on January 1, 2028.
