CPT Codes for Telehealth Visits: 2026 Billing Guide

CPT codes for Telehealth describe professional services performed through telecommunications technology and allow for clinical work to be coded appropriately. The list of CPT codes for the year 2026 contains over 11,520 codes beginning from January 1, 2026, and according to AMA, CPT enables proper coding and billing. Besides, the Medicare list of telehealth services is revised annually by CMS; thus, the right selection of the codes is essential.

However, the billing process does not end with the selection of CPT codes only because it also includes taking into account the modality of the service, documentation, modifier, and place of service (POS). POS 02 means telehealth services performed outside the patient’s home, and POS 10 refers to telehealth services in patients’ homes. CMS estimates the Medicare telehealth originating-site fee at $31.85 for 2026. Working with an experienced medical billing company can support practices manage telehealth claims, payer requirements, and reimbursement more professionally.

What Are Telehealth CPT Codes?

Telehealth CPT Codes are five-digit standardized codes to report the services provided to patients using digital communications. According to the American Medical Association, CPT stands for the standard language for documenting physician and qualified health care professional services. In 2026, CPT code set consists of more than 11,520 codes that are used to document, process claims, pay, and exchange information among U.S. providers and payers.

Terms ‘telemedicine’ and ‘telehealth’ are often interchangeable, while coding is more focused on the reported service and modality. Starting from 2025, CPT added a separate telemedicine code such as 98000–98007 – synchronous audio-video E/M; 98008–98015 – synchronous audio-only E/M codes. These codes describe the virtual encounter and not the mode of communication, as opposed to telehealth modifiers.

In 2026, the crucial challenge of the coder is payer policy. CPT has adopted telemedicine codes, whereas Medicare uses a separate telehealth payment system and a list of covered services. In 2026, CMS expanded its service list and simplified the way the services are included in the list, with special attention paid to the audio-video capability. Thus, the payer policy should be taken into account first by the coder.

Expert Insight:  Always check with the payer to determine their current telehealth policies before selecting a CPT code. Depending on the payer, modality, the location of the patient, and other factors, what is coded can vary from payer to payer.

Telehealth CPT Codes for 2026

CPT coding in telemedicine for 2026 will require the coder to identify the right family of CPT codes, communication mode, patient condition, and the work involved. CPT codes beginning with 98000 have been designated to identify synchronous telehealth visits, and 98016 identifies a brief virtual communication. Tele-E/M services are separately categorized by 99421-99423.

CPT 98000–98007: Telehealth E/M Services

The codes CPT 98000 to 98007 represent synchronous audio/visual E&M services. Codes 98000 to 98003 relate to visits of new patients whereas codes 98004 to 98007 relate to established patients, based on the level of E&M criteria that are applicable to the visit. According to AMA, these codes are telemedicine specific, and CMS has included these codes in its 2026 coding system.

CPT 98016: Virtual Check-In

This CPT code stands for brief communications-based service technology, such as a virtual check-in, for an existing patient. According to AMA, CPT code 98016 became a replacement for CMS HCPCS code G2012 for the virtual check-in arrangement. It is different from a complete E/M visit and is not intended for situations when the communication becomes a separately billable service.

CPT 99421: Online Digital Evaluation and Management

According to CPT code 99421, an online digital E/M service is billed when the physician spends between 5 and 10 minutes of their cumulative time spent during the week in the provision of services to an established patient. This encounter is usually done through the use of a patient portal or other digital means but not a live video. The patient initiates the encounter.

CPT 99422: Online Digital E/M Service

Code 99422 is to be used when an encounter of an established patient using a digital E/M encounter on the internet involves 11 to 20 minutes of total work performed by the physician over a period of seven days. This coding is to be used when the portal interaction necessitates clinical evaluation/management rather than administrative action.

CPT 99423: Online Digital E/M Service

The CPT code 99423 is applicable for online digital E/M service of an established patient taking 21 or more minutes in total of work by the physician within a week. It is the highest time tier among 99421, 99422 and 99423 codes. This type of service should be provided through substantive clinical evaluation or management and not routine scheduling or prescription requests.

When to Use Each Telehealth Code

Code assignment is supposed to start from the nature of the encounter and not the amount of reimbursement. Codes 98000–98007 will apply to synchronous audio and video E/M encounters while code 98016 applies to qualifying brief synchronous communications. On the other hand, codes 99421–99423 will be used for patient-initiated E/M services using online digital media for up to seven days.

CPT 99213, 99214, and 99215 for Telehealth

Despite being established patient office outpatient Evaluation and Management (E/M) codes, CPT codes 99213, 99214, and 99215 can be used in telemedicine billing according to the specific payer and circumstances of the service. Nevertheless, one needs to remember that it does not mean all the virtual visits require use of these codes. The telemedicine services list is annually updated by Medicare.

Telehealth E/M CPT Codes

Telehealth E/M Coding involves the use of the exact process used for office E/M Coding; that is, determining whether the patient is either new or established, then choosing the level through medical decision making (MDM) or total time as allowed by the code. CPT codes 98000-98007 address synchronous audio-video encounters, with 98000-98003 for new patients and 98004-98007 for established patients.

The most prevalent mistakes include choosing the level based on the complexity of the case only, not observing the threshold time stated, and assuming that every virtual encounter is eligible for 98000 codes. According to CMS, the documentation should support the code billed and the medical necessity. The telehealth list by Medicare is revised every year. Thus, providers need to confirm all these factors before billing.

Telehealth Modifiers in 2026

Modifiers related to telehealth services specify how a covered service was provided, enabling payers to distinguish between synchronous video calls and audio only calls. As for 2026, the choice of a modifier is dependent on the communication mode, the CPT code billed, the location of the patient, and payer policies. Even if a proper CPT code was used, a claim can be wrong if the modifier is inappropriate.

Modifier 95: Synchronous Telemedicine Service

Modifier 95 indicates that the service has been performed via audio-video telecommunications in real time. The use of modifier 95 should occur when both the procedure code allows it and the payer mandates the use of the modifier. It should be noted that modifier 95 alone does not confer eligibility for telemedicine services.

Modifier 93: Audio-Only Telemedicine Service

Modifier 93 is for an interactive, real-time audio-only telehealth service. This applies when the communication happens via the phone or equivalent audio-only technology, and the billed service falls under the category of audio-only reportable services. The difference between modifier 93 and modifier 95 is significant, as modifier 93 indicates the absence of any visual component during the encounter.

When to Use Each Modifier

Select modifier 95 if the encounter involves audio and video interaction and the payer supports reporting using modifiers for telehealth services. Select modifier 93 if the encounter is an audio encounter only and the service qualifies as such. The medical documentation should reflect the means of communication, among other criteria for the service being billed.

Modifier Requirements by Payer

The requirements for modifiers will differ from one payer to another. It is known that some Medicare professional claims may depend more on the right POS code as compared to modifier 95. Also, the audio-only Medicare claims might require modifier 93. Therefore, the coders have to check all the conditions set by the specific payer prior to claim submission.

Modifier 95 vs. Modifier 93

The easiest way to differentiate between the two is 95 for live audio and video telehealth, and 93 for live audio only. However, modifier selection cannot be done in isolation from CPT codes and payers. While some payers might not have any modifier for specific telehealth claims, there are also some that will need one.

Telehealth Place of Service (POS) Codes

The Place of Service codes indicate the location of delivery of the telehealth service, thus constituting an important claim data element. In 2026, POS codes 02 and 10 will differentiate between telehealth services that are not delivered in the patient’s home and those that are. Such a differentiation is important for reimbursement methodologies under Medicare.

POS 02: Telehealth Provided Other than in the Patient’s Home

The use of POS 02 occurs if the telehealth service provision is not provided when the individual is at home. Such cases may be a physician to patient visit where the individual is in an office, clinic, school, or any other designated location. The billing code gives the exact location for the telehealth service provision.

POS 10: Telehealth Provided in the Patient’s Home

POS code 10 is assigned to the case where the telehealth service is provided to the patient who happens to be located within a private residence. It is important to note that this code is determined by the location of the patient at the time of the encounter, and not that of the provider.

POS 02 vs. POS 10

The key here is quite simple: If the code is POS 02, then the patient is somewhere else, and if the code is POS 10, the patient is at home. The issue needs to be clarified based on the situation of the encounter and needs to be consistent. Switching between the two codes may cause a distortion of where the service was provided.

How POS Codes Affect Claims and Reimbursement

POS code gives information about the place in order to process claims for professionals and payment rules applicable to the claims. For the Medicare program, telehealth services furnished in the place of service 10 by the patient in his or her home shall be paid on a non-facility basis from January 1, 2024.

Common POS Coding Errors

Common mistakes made include the use of code POS 02 when the patient is at home, the use of POS 10 even though the patient is not there but somewhere else, and considering the location of the provider instead of that of the patient. The other error made is assuming that all payers follow the same rule on POS codes.

Medicare Telehealth CPT Codes and Billing

Medicare telehealth billing in 2026 depends on whether the service qualifies under the federal telehealth benefit, the applicable CPT or HCPCS code, and current coverage rules. The covered-service list is updated annually, while billing professionals must distinguish Medicare telehealth services from other communications-based services. This makes verification of the current code, coverage status, and payment rules essential before claim submission.

For professional claims, providers generally report the appropriate CPT or HCPCS code with POS 02 when the patient is not at home or POS 10 when the patient is at home. Medicare pays home-based telehealth at the non-facility rate. Where applicable, practitioners must also follow modality-specific modifier requirements, while the 2026 originating-site facility fee is $31.85, subject to Medicare’s payment formula and cost-sharing rules. You also need to explore how much medical billing outsourcing costs in 2026, including common pricing models, fees, hidden expenses, and potential ROI for healthcare practices.

Provider eligibility and patient setting requirements continue to be key for Medicare billing. Eligible providers are required to be eligible per relevant state laws, and the claim will be adjudicated based on the billing jurisdiction of the provider. Additionally, in 2026, Medicare still offers special telemedicine benefits for teaching physicians and offers unique requirements for originating site and facility fees. Consequently, the coder needs to check all these things for each claim.

Telehealth Documentation Requirements

A telehealth note needs to establish the nature of the service that was provided, why it is medically necessary, how it was provided, and the tasks that were done. The note needs to have information on the date, the patient and provider locations, the mode of communication, relevant clinical information, assessment, and plan. If the services provided are E/M services, the note needs to support the coding used.

The patient’s consent should be documented when it is required for the particular service and payer, whereas the documentation must clearly show which mode of communication was used for the particular encounter – whether video, audio or any other allowed method. Recording the date and time of the encounter, patient location, practitioner location, and communication method establishes the link between the clinical encounter and the claim filed.

Supporting documentation must include detailed clinical information to justify the diagnosis, the medical decision-making, the delivered services, and the billing code level. The documentation should be completed during or shortly after the encounter and should be kept as required by the rules of the applicable record-maintenance requirements. Medicare demands from telehealth-based practices to keep accessible medical records and deliver them on request.

How to Bill a Telehealth Visit

A telehealth visit cannot be billed by merely adding a modifier; it involves a series of steps relating to the clinical aspect, coding, and payer requirements. This involves establishing whether one qualifies for a telehealth billing and which modality will be used, followed by the matching of codes.

Step 1: Determine Whether the Service Qualifies as Telehealth

Firstly, it must be determined whether the encounter is eligible as per the criteria for telehealth according to that particular payer. It should be ensured that the method of communication, location of the patient, eligibility of the provider, and whether the service falls into the criteria for telehealth of that particular payer must be confirmed.

Step 2: Select the Appropriate CPT Code

Choose the proper CPT code based on the type of clinical service provided, patient condition, nature of the work done, and other considerations. Do not select a code just because the visit was done using telehealth. Billing for telehealth may use E/M codes, telehealth codes, digital technology services, or another type of qualifying codes, among others.

Step 3: Determine Whether a Modifier Is Required

Once you identify the CPT code, consider if the payer will require the telehealth modifier. Communication modality is a crucial consideration in this regard, since a video call and an audio call could be required to have different modifiers. If Medicare is the payer, there is a possibility that the qualifying audio calls would need 93 and/or FQ.

Step 4: Select POS 02 or POS 10

Use the correct POS code according to where the patient was found rather than where the service was rendered by the provider. Code 02 refers to telehealth services conducted at a location other than the patient’s home while code 10 refers to those that were conducted at the patient’s home.

Step 5: Verify Payer-Specific Requirements

It is important to verify the payer’s needs related to the services provided, CPT codes, modifiers, POS codes, provider eligibility, documentation, and patient location before submitting the claim forms. Medicare, Medicaid, and other commercial payers might have different criteria regarding telehealth. Medicaid programs vary from state to state, whereas private insurers can determine their own rules.

Step 6: Submit the Claim

If validation is successful for coding and documentation, then the claim form needs to be submitted with all the necessary patient, provider, diagnosis, CPT/HCPCS, modifiers, and payer information. The claim form should have accurate linkage between the patient encounter and the billed service. Prior to submitting, automatic/manual claim edits can catch errors that could have been avoided.

Step 7: Review Payment and Denials

Claim submission is just not the last part. Check out the remittance advice to know whether the service has been paid, discounted, or rejected due to the root cause of the problem. Some frequent problems include coding errors, modalities that don’t match, POS errors, modifier errors, and eligibility concerns. Identifying the pattern of denial will help fix billing problems in the future.  When telehealth claims are denied because of coding, coverage, or documentation issues, denial management services can help identify causes and follow appropriate resolution.

Professional Guidance: Develop a telehealth billing process tailored to your specific payer that checks for payer eligibility, CPT code selection, modality, modifier, place of service, and documentation prior to claims submission. This up-front validation may help you avoid unnecessary denials and ensure proper coding and coverage.

Telehealth Reimbursement Rates in 2026

Telehealth billing depends on the CPT/HCPCS code, payer fee schedule, geographic modifier, and place of service as opposed to one national rate for telehealth visits. For Medicare claims, the physician fee schedule determines the amount to be paid, while POS 02 and 10 may affect the payment method. For the year 2026, the originating site facility fee under the Medicare program is $31.85.

Commercial plans have contracts, and payment varies from one insurer to another based on the plan, state regulations, negotiated prices, CPT code, and whether it’s billed the same way as face-to-face visits. It can also be affected by the facility vs. non-facility modifier, which usually pays POS 10 services at the non-facility rate under the Medicare program. Practices looking to reduce administrative workload can outsource medical billing services to advance billing efficiency and keep consistent revenue-cycle processes.

Telehealth Billing Guidelines by Payer

There are significant variations in the telehealth billing guidelines for each payer, thereby making it unwise to use the same coding method. Medicare has a set list of telehealth services, along with POS requirements and appropriate modifiers. Medicaid programs have considerable flexibility at the state level, while commercial insurers and Medicare Advantage Plans could use their own policies depending on their contracts. Workers’ compensation programs follow state-level and program guidelines. These variations influence the coverage, coding, and payment.

The provider has to verify all the required information about payer’s covered CPT/HCPCS codes, eligible providers, modality requirements, patient location, POS, modifiers, documentation requirements, authorizations, and payment details. Medicare 2026 guidelines include in excess of 250 payable telehealth codes, while Medicaid guidelines could vary considerably depending upon the state.

Common Telehealth Billing and Coding Errors

However, telehealth claims can be denied despite proper provision of the clinical service due to improper coding. Some of the critical areas include choice of the CPT code, modifiers, place of service codes, documentation, insurance coverage, patient status, insurance policies, and duplication. Determining some of these denial issues prior to filing of the claim would save one a lot of hassle. Professional medical coding services can help confirm accurate CPT, modifier, POS, and documentation alignment for telehealth claims.

Using the Wrong CPT Code

Choosing the CPT code only based on the fact that a service was done virtually is one of the common mistakes made by providers. The choice of code will depend on the clinical service provided, the condition of the patient, its complexity, and the time or MDM requirement. Telehealth-specific codes, regular E/M codes, and digital codes each have their reporting criteria.

Incorrect Modifier

The inappropriate use or inclusion of a modifier can make the claim subject to failure in the automated payer edits and may not accurately describe how the care was provided. The choice of the modifier depends on the mode of communication and payer requirements. For instance, audio and audio-video consultations may have different coding practices.

Incorrect POS Code

POS codes are often incorrectly recorded when billing agents input the place where the service was performed by the provider rather than the place where the service was received by the patient. POS 02 indicates that the service was performed anywhere but at the patient’s place of residence. POS 10 indicates that the service was performed at the patient’s place of residence.

Missing Documentation

Incomplete charting dilutes the link between the face-to-face encounter and the billing code. The documentation must be sufficient for supporting the diagnosis, medical necessity, procedure performed, modality used, place of service, and E/M components. Timed codes need proper time documentation. Proper charting at the right time and proper support for the codes claimed can help one pass any review process.

Billing Services That Are Not Covered

The clinical appropriateness of a service does not necessarily mean that the service will be covered by all telehealth plans. The coverage of the service is dependent on many factors including the payer of the service, the nature of the service, the eligibility of the practitioner, the modalities utilized, the setting of the patient, and the applicable policy. The Medicare telehealth service list is updated annually.

Incorrect Patient Status

Using the wrong patient code either for an existing patient or for a new patient will result in improper payment and claim denial. Whether it is a new or an existing patient must be decided based on the CPT guidelines and not just because it is an online visit. The professional and documented relationship will help in choosing the correct category of patient.

Failing to Verify Payer Requirements

Telehealth regulations vary from Medicare to Medicaid to commercial insurance plans. The guidelines may vary based on the codes billed, the modifiers used, place-of-service billing, eligible providers, documentation requirements, preauthorization and reimbursement. Therefore, depending on one standard for telehealth billing poses a great risk. The payer’s current regulations should be verified before any submission.

Duplicate or Overlapping Claims

Overlapping claims can be generated where there is double entry of the service encounter using different CPT codes, when the service is repeated, or when the service is performed along with others which are not permitted under coding rules to be combined with each other. The procedure-to-procedure edit is meant to prevent improper reimbursement of such code combinations.

Best Tip for Success: Consider telehealth claim accuracy to be an initial stage of quality assurance rather than an error correction after denial. Verify the CPT code, patient eligibility, mode, modifier, POS, and other documentation as one package, and then review the payor-specific edits prior to claim submission.

Telehealth CPT Codes 2026 Quick Reference & Billing Compliance 

How Stream RCM Helps with CPT Codes for Telehealth

The Stream RCM service enables providers to handle the intricacies involved in coding and billing for telehealth services through its assistance in the selection of appropriate CPT codes, modifier/POS reporting, documentation review, claims filing, and denial management. The revenue cycle model followed by Stream RCM could enable providers to recognize any inconsistencies in coding, payer specific criteria, and revenue challenges even before it impacts their revenue streams.

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