Telehealth billing is undergoing a revolution as healthcare providers adapt to the increasing demand for virtual care. In 2025, several key updates and strategies are emerging to navigate the complexities of telehealth payments:

Key Updates and Strategies

Evolving Medicare Policies: Medicare has extended many telehealth flexibilities initiated during the COVID-19 pandemic through March 2025, reflecting the growing recognition of telehealth's role in improving healthcare access. However, providers must stay vigilant about evolving policies, especially concerning geographic and site-of-service requirements that may change post-March 2025.

CPT Code Updates: For mental health telehealth, commonly used CPT codes like 90791, 90792, 90832, 90834, 90837, 90846, and 90847 continue to apply when services are performed via live video or audio-only platforms, provided they meet Medicare’s coverage requirements. Modifier 95 should be appended to indicate telehealth delivery.

Expanded Audio-Only Coverage: Medicare has expanded coverage for audio-only mental health services in certain situations, ensuring accessibility for patients without video-capable devices.

Reimbursement Parity: Medicare’s reimbursement policies for telehealth in 2025 emphasize parity between telehealth and in-person visits for many services. However, reimbursement rates may vary based on provider type, service delivery mode, and compliance with coding and documentation requirements.

Importance of Modifiers: Accurate coding is crucial for telehealth reimbursement. Key modifiers include Modifier 95 (telehealth service), Modifier GT (interactive audio and video telecommunications), and Modifier FQ (audio-only telehealth services).

AI and Automation: AI and automation are accelerating claims submission and making data entry error-free, minimizing wasted time and improving cash flow for healthcare providers.

Cloud-Based Billing: Cloud-based billing provides a secure, inexpensive, and flexible solution with remote access, automatic updates, and integration into EHRs, improving accuracy and productivity.

EHR Integration: Integration of Electronic Health Records (EHR) reduces errors, shortens the time needed to file claims, and improves patient satisfaction and revenues by automatically feeding data into billing systems.

Challenges and Considerations

Regulatory Compliance: Frequent amendments in health service regulations bring new coding principles and billing procedures that need constant updates in billing systems.

Cost of Operation: Advanced billing technologies like AI and cloud systems can be expensive for smaller practices, requiring a significant initial investment.

Data Security: Maintaining data security is crucial when using cloud-based systems and other technologies.

Payment Trends

Alternative Payment Methods: Patients are demanding expanded ways to pay their bills, including digital wallets like PayPal, Apple Pay, and Google Pay.

Real-Time Pricing Tools: Real-time pricing tools are emerging to provide up-to-the-minute pricing, increasing transparency and helping to make procedure costs fairer.

By staying informed about these updates, trends, and challenges, healthcare providers can optimize their billing practices, ensure compliance, and continue delivering high-quality care to patients in the evolving telehealth landscape.