As 2026 is about to start, telehealth billing continues to evolve, bringing new opportunities for providers. In addition, the technology advancement is also redefining telehealth care by making it accessible to patients. Similarly, new codes (98000-98015) are replacing the older telehealth billing codes.
While providers can still use (98000-98015) codes for the E/M (evaluation and management), as they align with the new criteria. This blog will explore the important teletherapy billing updates.
Understanding Teletherapy Billing
Telehealth/teletherapy involves the use of technology to provide healthcare services without being physically present at the patient`s destination. Healthcare experts use various electronic tools and media such as video calls, image sharing tools, including both wired and wireless.
Once the provider is done with treating the patient, he documents the procedures, assigns codes, and files a claim to get reimbursement from the insurance payers.
Here is why telehealth billing is important
- Enhances continuity of care.
- Reducing travel issues.
- Overcoming clinical shortages.
- Timely care
New Telehealth Billing Updates
Congress passed the Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act of 2025. This act aims to extend the telehealth billing for the sake of increasing remote healthcare. Below are the key updates:
- Removing location restrictions: The New Act removes the location barriers, allowing patients to access healthcare services from anywhere in the United States.
- Providers Expansion: The act also included telehealth care providers to make telehealth accessible everywhere.
- Coverage Updates on Audio Telehealth: Insurance coverage for the audio-only healthcare will end with effect on 31st Dec.2025.
- Hospice Care Recertification: Telehealth care will remain effective for an in-person encounter before hospice care notification.
Telehealth Billing Code Updates
Above mentioned act also introduced 17 new billing codes for online healthcare, including both audio and video services. These codes (98008-98015) align with updates to MCM (Medical billing making) and time-backed threshold from newly revised E/M (evaluation and management guidelines.
Following these updates will help providers to accurately code the service and determine the complexity of a patient visit. However, Medicaid and Medicare are still not following these updates due to limitations in state laws.
Here is a list of new codes
| For new patients: | For new patients: |
| 98000: Straightforward medical decision-making (MDM) or 15-29 minutes. | 98008: Straightforward MDM or 15-29 minutes. |
| 98001: Low MDM or 30-44 minutes. | 98009: Low MDM or 30-44 minutes. |
| 98002: Moderate MDM or 45-59 minutes. | 98010: Moderate MDM or 45-59 minutes. |
| 98003: High MDM or 60-74 minutes. | 98011: High MDM or 60-74 minutes. |
| For visits lasting over 75 minutes, use prolonged services code 99417 (non-Medicare) or G2212 (Medicare). | |
| For established patients: | For established patients: |
| 98004: Straightforward MDM or 10-19 minutes. | 98012: Straightforward MDM or 10-19 minutes. |
| 98005: Low MDM or 20-29 minutes. | 98013: Low MDM or 20-29 minutes. |
| 98006: Moderate MDM or 30-39 minutes. | 98014: Moderate MDM or 30-39 minutes. |
| 98007: High MDM or 40-54 minutes. | 98015: High MDM or 40-54 minutes. |
| For visits lasting over 55 minutes, use prolonged services code 99417 (non-Medicare) or G2212 (Medicare). | |
Reimbursement for New Codes
Payers in the United States operate on different polices. Therefore, some organizations changed the amount paid for telehealth billing services while others kept it same even after the updates. Although the telehealth service cost was lower than the fee paid for an in-person visit, the updates aimed to modify the amounts.
In addition, the new codes for telehealth billing services help providers differentiate between online and in-person healthcare services and get quick reimbursements.
Benefits of Telehealth Updates
Process Efficiency: Recent updates allowed providers to increase their offer of patient care on a larger scale, enabling them to treat patients anywhere in the US. In addition, the providers were allowed to offer services 24/7.
Lower Costs: Increased virtual treatment updates led to a reduction in facility visit travels, lower staff, leading to faster and accurate reimbursements.
Easy Access. Patients in the urban areas now have access to a professional doctor through electronic mediums, resulting in a smooth and improved patient satisfaction.
Telehealth Billing Challenges
Despite the telehealth billing updates, this industry is facing numerous challenges that can negatively impact revenue growth.
- Payers Patchwork: Medicare`s denial to accept the new updates is encouraging hybrid billing. However, private insurers are reimbursing at 100% parity. This inconsistency results in claim rejections and revenue loss.
- Reimbursement Cuts: The 8% reduction in the PFS conversions affects the healthcare payments without further extensions. On the other hand, the same update requires patients to visit the facility for treatment, increasing the administrative costs.
- Outdated Technology: Outdated technology resulted in EHRs lagging in integrating new modifiers (93,95, FQ), resulting in unwanted errors in POS selection and modifier implementation.
Ending Notes
Teletherapy or telehealth billing updates brought major changes to the way telehealth was operating previously. It brought various benefits, such as improved patient care for the individuals living in rural areas. Moreover, providers were allowed to check patients 24/7, leading to increased reimbursements.
These changes resulted in various challenges as well. Firstly, Medicaid denied the updates, claiming that a physical visit is mandatory for the checkup. Moreover, outdated technology resulted in slower and poorer integration of EHRs.
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Frequently Asked Questions
What are the teletherapy Services?
Teletherapy service involves offering mental health treatment online through voice calls and video calls.
What do Teletherapy experts do?
They treat mental illness and address problems like emotional and psychological disorders.
What are the recent changes in teletherapy billing?
After 30 September 2025, the patients need to visit a medical facility for treatment.
Can 99214 be billed for the telehealth?
Providers can assign this code and get reimbursement from the insurance providers.
What is the future of teletherapy billing?
The AI revolution will result in more advanced teletherapy services, enhancing process efficiency and improving patient care standards.