Delivering care via telehealth is an important part of keeping up with innovation and patient demand for many private practices. With the right telehealth platform, seeing patients via synchronous video is both easy and efficient. But the requirements and regulations surrounding telehealth billing can be anything but.

This guide brings together must-have references for telehealth services and telemedicine. You will find plain-language steps on codes, modifiers, and place of service rules, plus what to verify with each payer. We also note 2025 updates that affect providers, reimbursement, and coverage across healthcare programs so teams can confirm current policy before submitting claims.

There are 6 steps to proper telehealth billing:

For Medicare, CMS maintains Medicare telehealth services under the annual physician fee schedule. Key 2025 updates flow through the final rule, which sets coverage and payment mechanics for virtual care and clarifies items that remained after the public health emergency (PHE) waiver period. Verify current allowances before you bill.

For Medicaid, states administer Medicaid services and benefits, so coverage varies. Check state rules, especially for managed care arrangements, and confirm plan specifics for Medicare Advantage when patients are enrolled there instead of Original Medicare. Start with the federal overview, then confirm state and plan details.

Before filing, confirm any state updates and plan bulletins. When double-checking coverage and payment language, favor official .gov sources.

Congress did not pass a continuing resolution by September 30, so several Medicare telehealth flexibilities expired on October 1, 2025. CMS issued an MLN notice directing MACs to place a temporary claims hold (about 10 business days) to avoid mass reprocessing if Congress restores coverage. 

You can submit claims, but payment is held until that pause lifts. Expect tighter rules on originating site (home generally no longer eligible), geographic limits, narrower audio-only coverage, and changes for FQHC/RHC distant-site billing, with behavioral health exceptions. Verify plan bulletins before scheduling.

Here's what to verify now:

Rules distinguish the originating site from the distant site, and many policies recognize the patient's home. Some also include a nursing facility. Billing can differ in inpatient and outpatient settings, so match codes and documentation to the setting you used.

FQHC sites (federally qualified health centers) and RHCs (rural health clinics) often have specific flexibilities and payment methods. Review your state's telehealth policy and plan contracts each year to confirm what applies to your teams.

Pick codes that reflect the service delivered and the technology used. Start simple. Map the visit type, then confirm payer rules before you submit:

Disclaimer: Policies vary by payer. Always confirm code lists, POS code use, and modifier requirements with the plan before filing the claim.

Reimbursement follows the contract you bill against. In fee-for-service, the payer pays for each covered unit once a clean claim is on file. In managed care, including Medicare Advantage, plans apply federal baselines and their own coverage criteria. Check plan materials before the visit so there are no surprises.

Coverage depends on who can bill and who is enrolled. Eligible clinicians and the beneficiary's plan status determine whether telemedicine services and other health services are payable. Medicare sets the starting point for virtual care. State rules and commercial policies layer on top. For state-by-state lookups, review the CCHP state telehealth policies and confirm details with each plan.

Here's a quick checklist:

Staying strict on eligibility, code selection, and documentation reduces rework and keeps reimbursement predictable across fee-for-service and managed care.

Some services and settings have extra rules. Review what is covered, who can deliver it, and what documentation each plan expects.

Coverage lists can change. So, recheck your plan guidance for telemedicine services when you add a new program, expand a setting, or update workflows.

Use this quick checklist to standardize records for virtual care. It helps teams capture what payers expect, avoid preventable edits, and keep claims moving. Complete these steps before and after the visit to support clean telehealth billing.

Clean telehealth billing and virtual care start with consistent documentation. Confirm the codes, the modifier, and the POS code before you submit. Verify payer rules for coverage and cost sharing so reimbursement stays predictable. Keep notes clear about the modality and the service delivered, especially for telemedicine services.

Teams of providers and every healthcare professional involved should review policies on a set cadence and update checklists as rules change. If you want tools that help standardize coding and claims workflows, check out the Tebra EHR software. For more guides and insights across private practice operations like this one, explore our resources on Tebra's resource and knowledge base. 

When a coding question pops up or a plan wants a citation, start here. These resources are reliable, kept current, and easy to navigate. Bookmark the CMS hub for national rules, use CCHP for state changes, and lean on AMA guidance for day-to-day questions. Whenever possible, rely on official gov pages.

If a plan requires specifics beyond these, review its policy manual and any plan FAQ pages before scheduling or submitting claims.