Preparing for 2026: Telehealth Coding & Billing Essentials (Member Resource)-Session Recording

Video Transcription

Video Summary

In the webinar "Telehealth Coding and Billing Essentials, Preparing You for 2026," Carolyn Millett, along with Antigone Argerio and Joseph Shivers, discussed practical and regulatory aspects of telehealth billing amid ongoing policy changes. They highlighted the importance of checking payer-specific policies, noting that Medicare coverage for telehealth services has paused due to a government shutdown starting October 1, 2023, except for behavioral and mental health services which remain payable. Providers should consider issuing advance beneficiary notices informing patients of possible non-coverage to share financial liability.<br /><br />Billing for synchronous audio-video telehealth typically uses standard Evaluation and Management (E&M) codes with modifier 95 and place-of-service codes (10 for home, 2 for other locations), but audio-only services generally lack reimbursement, particularly for Medicare after recent changes. Telehealth is generally allowed for both new and established patients, although physical exams remain challenging remotely, and prescribing controlled substances has temporary telehealth flexibilities through the end of 2023 but with potential restrictions in 2026.<br /><br />The AMA created a new set of telehealth-specific CPT codes for 2023 to better define these services; however, CMS has not accepted these codes for Medicare reimbursement, valuing telehealth visits equivalent to in-person visits using existing E&M codes. Private payers have varied approaches, with some beginning to adopt the new codes.<br /><br />Panelists discussed telehealth use cases in physiatry including follow-ups, medication renewals, imaging reviews, and rural patient access, while emphasizing the need for in-person visits when physical examination is essential. Challenges like connectivity issues often lead to hybrid approaches, blending telehealth with in-person care.<br /><br />They underscored ongoing advocacy efforts to preserve telehealth flexibilities and urged clinicians to stay current with evolving regulations to optimize telehealth's role in rehabilitation medicine.

Keywords

Telehealth Coding

Telehealth Billing

2026 Telehealth Regulations

Medicare Telehealth Coverage

Behavioral Health Telehealth

Evaluation and Management Codes

Modifier 95

Place-of-Service Codes

Telehealth CPT Codes 2023

Physiatry Telehealth Use Cases

Telehealth Advocacy