🌐 Introduction: Telehealth Isn’t Going Anywhere in 2025
Telehealth billing 2025 is reshaping how healthcare providers deliver and get paid for virtual care. With new CMS rules, modifier updates, and reimbursement models, accuracy in billing is more critical than ever.Telehealth is no longer an emergency alternative — it’s a standard part of healthcare delivery. In 2025, providers are seeing more virtual visits than ever, but with that growth comes new billing, modifier, and reimbursement challenges.
CMS and private payers continue to update their rules, creating confusion for practices trying to bill correctly. The result? Denials, delayed payments, and underpaid claims.
This guide breaks down the latest telehealth billing trends for 2025, key modifier updates, and how The Ashez Group helps providers get reimbursed accurately and on time.
⚖️ Telehealth Billing in 2025 — What’s Changing
The Centers for Medicare & Medicaid Services (CMS) and many private payers have permanently expanded telehealth coverage post-pandemic, but the rules keep shifting.
Here’s what’s new in 2025:
- Expanded CPT coverage: Codes like 90837, 99213, and 99457 remain billable via telehealth.
- Audio-only visits are still covered by many payers — but require specific POS and modifiers.
- Reimbursement parity continues, meaning telehealth visits are paid at the same rate as in-person visits — if coded correctly.
- Credentialing for telehealth is now mandatory with most payers before billing virtual services.
🧩 Correct Use of Telehealth Modifiers (95, GT, FQ, FR)
Modifiers are crucial in telehealth billing — and one of the top causes of claim denials. Here’s how to use them in 2025:
| Modifier | Use | Example | Common Mistake |
|---|---|---|---|
| 95 | Synchronous audio-video telehealth | 90837-95 (psychotherapy via video) | Using GT instead of 95 |
| GT | Still used by some Medicaid & private payers | 99213-GT (established patient via telehealth) | Using both GT & 95 together |
| FQ | Audio-only visit | 99441-FQ (phone E/M visit) | Missing FQ for audio-only claims |
| FR | Hybrid model (in-person staff with remote provider) | 99213-FR | Forgetting FR for shared/hybrid encounters |
👉 Pro Tip: Always check each payer’s telehealth billing policy — what works for CMS may differ for Aetna, Cigna, or BCBS.
🚫 Most Common Telehealth Denial Reasons in 2025
Despite broader coverage, telehealth claims are still denied for predictable reasons:
- Missing or incorrect modifiers (95, GT, FQ, FR)
- Wrong POS code (using POS 11 instead of 02 or 10)
- Uncredentialed provider or expired telehealth registration
- Incorrect CPT for telehealth setting
- Documentation missing synchronous vs asynchronous proof
Example:
A therapist bills 90837 (60-min psychotherapy) via telehealth but forgets Modifier 95. Claim is denied as “service not eligible for telehealth.”
✅ Fix: Submit 90837-95, POS 10 (patient home) → claim approved.
💰 Telehealth Reimbursement Trends: 2025 Outlook
- Parity Payments: Most commercial payers and Medicare continue paying the same for telehealth and in-person visits.
- POS 10 & POS 02:
- POS 10 = patient’s home (most common in 2025).
- POS 02 = telehealth outside home (e.g., another clinic).
- Increased Prior Authorization: Some payers now require pre-approval for repeat virtual sessions (especially for therapy).
Example:
A psychiatrist bills 99214-95 with POS 10. Claim paid at the same rate as an in-office visit.
But if billed with POS 11, it’s denied as “location not covered for telehealth.”
⚙️ How The Ashez Group Helps Providers Master Telehealth Billing
At The Ashez Group, we specialize in telehealth billing compliance and optimization.
Our team ensures that every claim meets payer-specific requirements — modifiers, POS codes, and documentation — to avoid costly denials.We provide:
- ✅ Correct modifier mapping (95, GT, FQ, FR)
- ✅ Payer-specific telehealth rules tracking
- ✅ Denial management for rejected telehealth claims
- ✅ Credentialing for virtual care expansion
- ✅ Automated reports for telehealth reimbursement trends
📈 Our goal is simple — make telehealth billing profitable, not problematic.
🏁 Conclusion: Telehealth Billing in 2025 Requires Precision
As telehealth becomes the new norm, billing accuracy determines profitability.
Providers who rely on outdated billing methods will continue facing denials and underpayments, while those who partner with experts like The Ashez Group will enjoy faster payments and compliance peace of mind.👉 Ready to optimize your telehealth billing in 2025? Contact us today for a free billing analysis.
