Current Procedural Terminology (CPT) codes are the set of codes used in medical billing. They indicate different diagnoses and treatment plans for the patients in a hospital. As technology is emerging in hospitals, billers are introducing CPT codes in telemedicine systems. With this adoption, healthcare providers are facing different challenges such as compliance issues. That is why, they hire professional medical billing firms like SysMD to use telemedicine codes in their practice.
In this blog post, we will provide the latest CPT codes for telemedicine. We will provide a complete guide on using these codes in routine practice. Further, we will provide Medicare guidelines so that you can maintain compliance.
What are CPT Codes for Telemedicine?
In telemedicine, billing staff use CPT to bill for virtual consultations, remote patient monitoring, and other telehealth services.
Some subcategories of these codes are as follows:
Modifier Codes
Some telemedicine services need modifiers such as 95 (synchronous telemedicine service) or GT (interactive audio and video telecommunication systems).
Place of Service (POS) Codes
Different telemedicine scenarios need specific POS codes like 02 (telehealth provided other than in the patient’s home) and 10 (telehealth provided in the patient’s home).
Evaluation and Management (E/M) Codes
These codes apply to virtual visits. Billing staff use these codes for remote consultations similar to in-person visits.
Latest Updates: Telehealth CPT Codes 2025
In 2025, Medicare introduced some updates in codes for telemedicine. It improves accessibility and reimbursement accuracy in telehealth billing.
Telehealth CPT codes 2025 with their functions are as follows:
Expanded Remote Patient Monitoring (RPM) Codes
These codes cover broad monitoring capabilities. They cover chronic disease management and post-surgical follow-ups.
Enhanced Mental Health Telehealth Codes
These codes are specifically designed for mental health patients. They are used for virtual therapy and psychiatric consultations.
Updated E/M Telehealth Codes
Medicare updated E/M telehealth codes. These codes reduce discrepancies in billing systems. They update these codes to ensure alignment with in-person visit reimbursement rates.
New AI-Powered Telehealth Codes
With the advancement in artificial intelligence, AI-powered telehealth codes are now used in telehealth billing. This CPT code for telemedicine is used for diagnostic evaluations. It shows advancements in virtual healthcare technology.
Revised Documentation Requirements
New coding guidelines are also based on documentation requirements. They focus on complete patient information and accurate documentation to streamline the billing tasks.
Understanding Audio-Only Telemedicine CPT Codes
CPT codes for telemedicine are very vast. Every category has a different series of code functions. Telemedicine is entirely dependent on virtual consultations in which audio is mainly involved. These codes are important for patients who do not have video access or those in rural areas with limited internet connectivity.
- 99441-99443: Telephone E/M services provided by a physician or non-physician practitioner.
- 98966-98968: Non-physician telephone consultations for behavioral health and counseling services.
Reimbursement Criteria
Medicare and insurance companies now recognize audio-only telemedicine CPT codes as reimbursable services. Billers should specify medical necessity in the documents and the length of the call.
Payers pay different numbers of payments for different patients because the length of video calls varies from patient to patient. Telehealth billing staff should verify policies with individual insurers.
How to Use Telemedicine Billing Codes?
Telemedicine billing is an innovative field, which is why proper education for billing staff is necessary. Proper coding for all virtual meetings is necessary. Otherwise, it will cause many billing errors.
A complete guide for using telemedicine billing codes in hospitals is as follows:
Identify the Correct CPT Code
Firstly, find the correct CPT for telemedicine service. Identify if the service falls under E/M, RPM, behavioral health, or another telemedicine category.
Use Appropriate Modifiers
Modifiers are the extra numbers that are used with telehealth codes. You should apply the correct modifier for successful claim submission. Usually, modifier 95 or GT is used to indicate telehealth service.
Select the Right POS Code
Then, mention the place of service with the right code. You can use 02 for facility-based telehealth and 10 for at-home telehealth visits.
Ensure Proper Documentation
Mention the reason for the virtual meeting including history, diagnosis, and treatment. You should also add the duration of the visit, and method of communication (video or audio-only) in the documents.
Verify Payer Policies
Claim approval directly depends on payer policies. That is why, you should verify the billing and coding guidelines of Medicare, Medicaid, or private payers.
Common Mistakes and How to Avoid Them
Incorrect Modifiers
Sometimes, billers put accurate code and inaccurate modifiers. It leads to claim denials and reduces reimbursement rates.
Incomplete Documentation
One of the most common reasons for claim denials in telemedicine billing is incomplete documentation. Every virtual visit must be thoroughly documented, including:
- Patient history: Key symptoms, previous diagnoses, and medical history.
- Reason for telemedicine visit: A clear explanation of why the patient needed a virtual consultation.
- Duration of the visit: How long the consultation lasted, as some codes are time-dependent.
- Method of communication: Whether the visit was conducted via video, audio-only, or a combination of both.
- Treatment plan: Any medications prescribed, follow-up instructions, or referrals.
How to Avoid This Mistake
Ensure that all telehealth services are fully documented according to Medicare and private payer guidelines. Use templates in electronic health records (EHRs) to standardize documentation and reduce errors.
Role of Medicare in Telehealth Reimbursement Codes
Medicare plays a significant role in shaping telehealth reimbursement policies. With the increasing adoption of telemedicine, Medicare continuously updates its remote patient monitoring codes and guidelines to ensure fair compensation for virtual healthcare services.
Key Medicare Reimbursement Policies for Telemedicine
Expanded Coverage
Medicare now reimburses for various telehealth services, including mental health counseling, chronic disease management, and post-surgical follow-ups.
Payment Parity
Medicare is aligning telehealth reimbursements with in-person visits, ensuring providers receive fair compensation.
Audio-Only Visits
Medicare now recognizes audio-only visits under specific CPT codes (99441-99443 and 98966-98968), which helps improve access to care for patients in rural areas.
Remote Patient Monitoring (RPM)
RPM codes (99453-99457) allow providers to bill for tracking patient vitals and chronic disease management remotely.
AI-Powered Telehealth
Medicare is considering AI-based CPT codes for diagnostic evaluations and automated health assessments.
Medicare Compliance Requirements
To ensure claims are approved:
- Use Medicare-approved CPT codes for telehealth services.
- Submit accurate documentation of the virtual visit.
- Verify modifiers and place of service (POS) codes before claim submission.
- Stay updated on Medicare policy changes, as telehealth regulations evolve frequently.
Best Practices for Telemedicine Coding Guidelines
Accurate coding and billing in telemedicine require adherence to best practices. Below are key strategies to avoid claim denials and maximize reimbursement:
Regular Training for Billing Staff
Since telemedicine billing is complex, hospitals should train their billing teams on CPT updates, Medicare policies, and payer-specific guidelines.
Use EHR Systems for Automated Coding
Electronic health records (EHR) can help assign appropriate CPT codes based on provider input, reducing human error in telemedicine billing.
Verify Insurance Coverage Before Appointments
Since different payers have unique policies, always check patient eligibility and insurance coverage before scheduling a telehealth appointment.
Apply Correct Modifiers and POS Codes
Ensure every telehealth service has the correct modifier (95, GT) and POS code (02, 10) to avoid unnecessary denials.
Maintain Accurate and Complete Documentation
Missing or incomplete details in documentation can lead to claim denials. Make sure to:
- Clearly define the reason for the telemedicine visit
- Mention whether it was video or audio-only
- Include a treatment plan and follow-up details
Appeal Denied Claims Promptly
If a claim is denied, analyze the reason, correct errors, and resubmit with proper documentation to avoid revenue loss.
Incorporate Telemedicine CPT Codes with SysMD
Are you facing difficulty in understanding CPT telemedicine codes? Do not worry, you can get help from an experienced and skilled platform, SysMD. Our billing services are for small as well as large clinical setups. We work dedicatedly on remote patient monitoring codes and maximize reimbursements for all healthcare organizations. Get any type of assistance from our reliable billing professionals in your billing and coding systems.
Conclusion
The latest CPT codes for telemedicine in 2025 have introduced expanded remote patient monitoring, enhanced mental health services, AI-powered telehealth, and improved Medicare reimbursement policies. With these updates, healthcare providers must stay informed about new coding guidelines, reimbursement policies, and proper billing techniques to ensure compliance and maximize revenue.
By using the right CPT codes, applying correct modifiers, selecting the appropriate POS codes, and maintaining thorough documentation, medical billers can successfully navigate telehealth billing and avoid claim denials. As telemedicine continues to evolve, staying updated with Medicare policies and private-payer guidelines will be essential for healthcare providers and billing staff.
Reach out to SysMD and avail the amazing opportunity of telemedicine billing services in your billing practice.
Incorporate Telemedicine CPT Codes with SysMD
Are you facing difficulty in understanding CPT telemedicine codes? Do not worry, you can get help from an experienced and skilled platform, SysMD. Our billing services are for small as well as large clinical setups. We work dedicatedly on remote patient monitoring codes and maximize reimbursements for all healthcare organizations. Get any type of assistance from our reliable billing professionals in your billing and coding systems.
Conclusion
The latest CPT codes for telemedicine in 2025 have introduced expanded remote patient monitoring, enhanced mental health services, AI-powered telehealth, and improved Medicare reimbursement policies. With these updates, healthcare providers must stay informed about new coding guidelines, reimbursement policies, and proper billing techniques to ensure compliance and maximize revenue.
By using the right CPT codes, applying correct modifiers, selecting the appropriate POS codes, and maintaining thorough documentation, medical billers can successfully navigate telehealth billing and avoid claim denials. As telemedicine continues to evolve, staying updated with Medicare policies and private-payer guidelines will be essential for healthcare providers and billing staff. Reach out to SysMD and avail the amazing opportunity of telemedicine billing services in your billing practice.
