Telehealth Reimbursement Rates and CPT Codes

Billing a telehealth visit isn't as simple as swapping a room for a screen — the payment machinery behind it involves specific procedure codes, payer-specific rules, and rate structures that can diverge sharply depending on whether the payer is Medicare, Medicaid, or a private insurer. CPT codes and reimbursement rates determine how much providers actually get paid, and the gap between what a practice bills and what it collects often comes down to which code was selected and whether the visit met the payer's eligibility criteria. This page maps the core coding framework, explains how rates are set, and identifies the decision points where billing errors are most likely to occur.

Definition and scope

A CPT code — Current Procedural Terminology, maintained by the American Medical Association — is a standardized five-digit numeric identifier attached to every billable medical service in the United States. For telehealth, CPT codes work in tandem with place of service (POS) codes and modifier codes to communicate three things to a payer: what service was provided, where it was delivered (or rather, through what channel), and what special billing conditions apply.

The two POS codes central to telehealth are POS 02 (telehealth provided other than in patient's home) and POS 10 (telehealth provided in patient's home), the latter introduced by CMS for 2022 claims. Modifier 95 signals that a synchronous telemedicine service was rendered via interactive audio and video. Modifier GT remains relevant for certain Medicare Advantage and Medicaid claims. Getting any of these wrong doesn't just delay a claim — it can trigger a denial or a compliance audit.

Reimbursement rates are set differently across payer types, which is where telehealth billing and coding becomes its own subspecialty.

How it works

Medicare sets the benchmark most other payers reference. Under the Medicare Physician Fee Schedule, telehealth services are reimbursed at rates tied to the Relative Value Unit (RVU) system — the same framework used for in-person services. For evaluation and management (E/M) visits, the most common telehealth encounter type, CPT codes 99202–99215 apply, with reimbursement ranging from roughly $46 for a new patient level-1 visit (99202) to over $230 for a complex established patient visit (99215), based on the 2024 Medicare Physician Fee Schedule published by CMS.

The billing flow for a typical telehealth E/M visit works like this:

1. Assign the correct E/M code based on medical decision complexity or total time — the same criteria as in-person visits since the 2021 AMA E/M guideline revisions.
2. Attach POS 10 or POS 02 depending on the patient's location at time of service.
3. Append modifier 95 to confirm the synchronous audio-video format met payer requirements.
4. Submit with the provider's NPI and confirm the rendering provider holds an active license in the patient's state — a requirement enforced by telehealth state laws and licensure frameworks.
5. Verify payment parity rules, if applicable — 24 states and Washington D.C. have enacted payment parity laws requiring private insurers to reimburse telehealth at in-person rates (National Conference of State Legislatures, 2023).

For remote patient monitoring, a distinct CPT code set applies — 99453, 99454, 99457, and 99458 — each covering a different phase of device setup, data collection, and clinical review time.

Common scenarios

Mental health visits are among the highest-volume telehealth billing scenarios. CPT codes 90832, 90834, and 90837 cover psychotherapy by time (16–37 minutes, 38–52 minutes, and 53+ minutes respectively), and these are frequently billed alongside an E/M code for medication management under add-on code 90833. The mental health telehealth context matters here because Medicare, unlike some private payers, has historically permitted audio-only mental health visits under CPT 98966–98968 when a patient lacks video capability — a carve-out that reflects real access constraints.

Chronic disease management encounters, common in telehealth for primary care, often involve both an E/M visit and separate codes for chronic care management (CCM) services — CPT 99490 and 99491 — which are time-based and require at least 20 minutes of clinical staff time per calendar month.

Store-and-forward services, explained in detail at store-and-forward telehealth, use a separate billing framework. Dermatology consultations submitted asynchronously are billed under HCPCS codes rather than standard CPT E/M codes in many state Medicaid programs, though Medicare coverage for store-and-forward remains limited to federal telemedicine demonstration programs in Alaska and Hawaii.

Decision boundaries

The single most consequential billing decision is parity vs. non-parity. In states without payment parity laws, private insurers may reimburse telehealth visits at 70–80% of in-person rates, or apply a separate, lower telehealth fee schedule entirely. Providers working across state lines — particularly relevant under telehealth policy and regulation — may receive materially different reimbursement for identical services depending solely on where the patient is located.

A second critical boundary involves audio-only visits. Medicare's pandemic-era flexibility extended coverage to telephone-only E/M visits (CPT 99441–99443), but these flexibilities are subject to ongoing Congressional reauthorization. As of the Consolidated Appropriations Act, 2024, audio-only telehealth flexibilities were extended through December 31, 2024 (CMS Telehealth Fact Sheet), but the longer-term status remains subject to legislative action. Providers billing audio-only visits should verify active coverage windows before submitting claims.

A third boundary involves originating site requirements — the historical Medicare rule restricting telehealth to patients in rural health professional shortage areas. Pandemic waivers removed this restriction, but its permanent elimination depends on legislation, a landscape tracked closely in telehealth post-pandemic policy changes. The originating site requirement, if reinstated, would render a large share of current telehealth billing for urban Medicare patients non-reimbursable overnight — which is a fairly dramatic sentence to have to write about a billing technicality.