A doctor does the exact same video visit twice and bills it the same way both times. One claim gets paid. The other one doesn’t. Telehealth rules keep changing, and payers still don’t all follow the same playbook.
A telehealth billing guide for 2026 centers on modifier 95 for live video visits, place codes 02 and 10 based on where the patient sits, and payer rules on which codes even qualify. Medicare, Medicaid, and private payers each handle these parts a little differently.
Modifier 95: What It Actually Tells The Payer
Modifier 95 shows the payer that a visit happened live, over video and audio together. It’s the single most important piece of a clean telehealth claim right now. Leave it off a video visit, and the payer may process it like a regular office visit instead. That mismatch alone causes a large share of telehealth denials.
- When You Should Add Modifier 95
Add it to the code for any live video visit. Don’t use it for phone-only calls or messages sent back and forth.
- A Small Mix-Up That Causes Big Problems
Some staff add modifier 95 to codes that were never approved for telehealth at all. That combo gets rejected fast, since the base code has to be on the payer’s approved list first.
Place Codes: The Difference Between 02 And 10
Place codes tell the payer where the patient was sitting, and that one detail changes how much gets paid. Two codes handle almost every telehealth scenario right now. Pick the wrong one, and the claim can process at a lower rate without any obvious error on the surface. Getting this right takes just one extra data point per visit.
- POS 02 Vs. POS 10, Made Simple
POS 02 means the patient was somewhere outside their home, like a clinic. POS 10 means the patient was at home. Medicare pays these two rates differently.
- Why Front Desk Teams Miss This Detail
Staff often collect the patient’s location for scheduling, but that detail doesn’t always make it into the billing system. It’s a small gap, but it causes a lot of denials.
Payer Rules Are Not All The Same
Medicare, state Medicaid plans, and private payers each keep their own list of codes allowed for telehealth.
- Medicare Updates Its List Often
Medicare adds and drops codes from its telehealth list on a set schedule. A code covered last year isn’t always covered this year.
- Private Payers Often Go Their Own Way
Private payers don’t always match Medicare’s list. Some cover codes Medicare skips, and some skip codes Medicare covers. Checking each payer’s list, code by code, isn’t optional anymore.
Edge Cases That Cause Denied Telehealth Claims
Audio-only visits and care across state lines cause billing problems that regular video visits don’t.
- Audio-Only Visits Need Their Own Codes
A phone call with no video doesn’t qualify for modifier 95. Some payers allow separate audio-only codes, but many still won’t pay for them. This ties into how audio-only visit notes work, worth a separate look on its own.
- Seeing A Patient In A Different State
A provider licensed in one state seeing a patient sitting in another state raises licensing questions before billing even starts. A visit that wasn’t legally allowed will get denied, and it can bring bigger problems too.
Billrhealth’s Telehealth Billing Help
At Billrhealth, we manage telehealth billing along with related work like behavioral-health billing, checking modifiers, place codes, and payer lists before every claim goes out; every project runs under clear terms and conditions, so your practice always knows what’s covered.
Ending Note
Telehealth billing punishes old habits more than most other specialties right now. Pull last month’s telehealth claims and check each place code against where the patient actually sat. That one check usually shows where your denials are coming from.
Frequently Asked Questions (FAQs)
- Does Modifier 95 Apply To Phone-Only Visits?
No, it’s only for live video visits, and phone-only calls need a separate audio-only code.
- What’s The Difference Between POS 02 And POS 10?
POS 10 means the patient was at home, while POS 02 covers any other location.
- Do Private Payers Follow Medicare’s Telehealth Rules?
Not always, since many private payers keep their own separate list of covered codes.