- Quick checklist of what this article will deliver:
- Clarify the most current telehealth billing codes 2025 and when to use them.
- Map documentation requirements telehealth claims and payer-specific rules.
- Explain coding nuances like coding teletherapy group CPT 90853 and telehealth place of service guidance.
- Give actionable teletherapy reimbursement tips for clinicians to increase successful payments.
Teletherapy Billing and Reimbursement 2025: Codes, Documentation, and Tips to Get Paid
Introduction: Why 2025 Matters for Teletherapy Reimbursement
Telehealth remains a core part of behavioral health delivery across the U.S. As policies continue to evolve, 2025 brings another year. Clinicians, billers, and practice managers must align coding, documentation, and payer rules. This alignment is crucial to protect revenue and patient access.
What changed heading into 2025: policy and coding updates
Heading into 2025, the framework for telehealth is stable. This is in contrast to the rapid changes of 2020–2023. Nevertheless, variability persists between payers and states. Key themes for 2025:
- Ongoing emphasis on clinical documentation to support medical necessity and to prevent denials.
For federal guidance, monitor CMS telehealth resources and state Medicaid bulletins:
- CMS Telehealth Overview: https://www.cms.gov/medicare/telehealth
- Medicaid telehealth resources: https://www.medicaid.gov/medicaid/benefits/telehealth/index.html
Who this guide is for: clinicians, billers, and practice managers
This guide was written for:
- Behavioral health clinicians providing teletherapy (individual and group).
- Medical billers and coding staff who submit telehealth claims.
- Practice managers negotiating with payers and setting operational workflows.
How to use this guide: practical checklist, coding references, and payer-specific paths
Use each section as a checklist:
- Confirm the correct CPT/HCPCS for the service.
- Choose proper modifier and place of service.
- Apply required documentation templates and consent records.
- Follow payer-specific guidance (private payers vs Medicaid).
Telehealth Billing Codes 2025 — What to Use and When
Overview of commonly used telehealth billing codes 2025
Common CPT codes used in teletherapy for mental/behavioral health:
- Psychotherapy: 90832 (30 min), 90834 (45 min), 90837 (60 min)
- Psychotherapy with evaluation/management when appropriate: selected E/M codes per payer policy
- Group psychotherapy: 90853 (see details below)
- Telephone and digital E/M: 99441–99443, 99421–99423 (telephonic/e-visits) — check payer acceptance
- Remote monitoring and digital therapeutics when relevant: 99453, 99454, 99457, etc., for remote physiologic/behavioral monitoring
Note: Not all payers reimburse every code for telehealth. Always confirm payer-specific telehealth billing codes 2025 via each payer’s fee schedule or provider bulletin.
Coding teletherapy group CPT 90853: rules and modifiers
Coding teletherapy group CPT 90853 requires careful documentation:
- Many private payers and some Medicaid programs allow CPT 90853 for teletherapy delivered synchronously by interactive audio-video. However, policies vary—some payers limit group telehealth coverage.
- Required documentation elements:
- List of participants with attendance start/end times.
- Group purpose and how each member benefits (ties to treatment plan).
- Clinical content showing active therapeutic intervention (not administrative or purely educational).
- Billing notes:
- Use modifier 95 (synchronous telemedicine) or payer-preferred telehealth modifier (e.g., GT) if required.
- Use Place of Service (POS) 02 for telehealth at many payers; some payers prefer the practitioner’s usual POS (e.g., POS 11) plus modifier 95 — check payer guidance.
- Some payers require a per-member unit (1 unit per attended member) and some require a single group claim with roster attached.
Practical tip: For group sessions, attach or maintain an attendance roster in the record showing each participant’s presence and the contribution of the session to the individual’s treatment plan.
When to add telehealth-specific modifiers and place-of-service guidance
- Modifier 95 — synchronous interactive telemedicine service rendered via real-time interactive audio and video.
- Modifier GT — legacy telehealth modifier sometimes still used by specific payers.
- Place of Service (POS) 02 — indicates the service was provided via telehealth; some payers prefer POS 02 with modifier 95, while others prefer the regular POS (e.g., POS 11) with modifier 95. Check payer-specific instructions.
Important: Mismatched modifier/POS combinations are frequent denial triggers. When in doubt, follow the payer’s published policy or contact their provider relations line.
Documentation Requirements for Telehealth Claims
Core documentation requirements telehealth claims: what payers expect
To satisfy documentation requirements telehealth claims, include:
- Patient consent for telehealth services (state and payer-specific consent requirements).
- Technology used and attestation that the encounter was synchronous audio-video (if required).
- Patient and provider location (originating site and distant site if required).
- Start and stop times for timed services (especially psychotherapy).
- Clinical content: subjective, objective (as applicable), assessment, plan.
- Medical necessity: clear linkage between diagnosis, symptoms, and the intervention provided.
Example consent language (short): “I consent to receive health care via telehealth and understand the limits and benefits.”
Notes that support medical necessity and credentialing
- Tie each session to the active treatment plan and problem list (e.g., “Session focused on CBT for panic disorder; patient shows 3 panic attacks/week; goals: reduce attacks to ≤1/week.”).
- Document goals, progress, and specific therapeutic techniques used.
- For Medicaid and some private payers, include provider credentialing details in enrollment and keep records up to date.
Common documentation errors and how to avoid denials
Common errors:
- Missing or expired telehealth consent.
- Failure to document start/stop times for timed psychotherapy codes.
- Incorrect modifier or POS pairing.
- Vague clinical notes not tied to diagnosis or treatment plan.
- Not recording participant list in group sessions.
How to avoid:
- Use standardized templates with required fields (consent, tech attestation, start/stop).
- Train clinicians on time-based coding and rounding rules.
- Implement pre-billing audits focused on modifier/POS consistency.
- Keep electronic rosters for group teletherapy.
Private Payer Rules — Coverage Checklist and Negotiation Tips
Private payer teletherapy coverage checklist
Use this private payer teletherapy coverage checklist before submitting a claim:
- Eligibility: Is the patient covered for telehealth services under their plan?
- Covered services: Are psychotherapy (90832/90834/90837), group therapy (90853), telephone E/M, and remote monitoring covered?
- Teletherapy platforms: Does the payer require specific HIPAA-compliant platforms or vendor attestations?
- Consent: Documented telehealth consent present in chart.
- Provider credentialing: Are you enrolled and credentialed with the payer for telehealth?
- Modifier/POS rules: Payer-specific rules for modifier 95, GT, and POS 02 vs regular POS.
- Prior authorization: Is prior auth required for teletherapy or specific codes (including group therapy)?
- Fee schedule: Confirm allowed amounts and any telehealth-specific reimbursement differentials.
- Timely filing and claim submission instructions.
How to interpret private payer policies and prior authorization requirements
- Read the policy bulletin line-by-line: look for service lists, excluded codes, and any required modifiers.
- Check the payer’s fee schedule for allowed amounts and service restrictions.
- Use payer portals to verify patient benefits and prior authorization requirements before the visit.
- When prior auth exists, capture authorization numbers and attach pre-authorization documentation to the claim if allowed.
Teletherapy reimbursement tips for clinicians when working with private payers
- Document medical necessity clearly and tie therapy sessions to measurable goals.
- Capture telehealth consent and platform attestation at intake and renew annually.
- Track and report utilization and clinical outcomes when negotiating with payers—data helps secure coverage and better rates.
- Use a standard appeals template when a denial occurs; include clinical notes, treatment plan, progress, and payer policy references.
- Keep a payer quick-reference sheet for modifier/POS preferences and prior authorization processes.
Sample appeals template (short):
Date:
Patient:
Insurance:
Claim number:
Service date:
Code(s):
Denial reason:
Appeal rationale: Attach clinical notes showing medical necessity, treatment plan, and telehealth consent. Cite payer policy permitting the service for telehealth if available.Medicaid and Public Payer Telehealth Billing Rules
Medicaid telehealth billing rules: state variations and key principles
Medicaid telehealth billing rules are state-specific. Key principles:
- States determine which services, providers, and modalities (synchronous vs asynchronous) are covered.
- Many states expanded telehealth during the pandemic and retained broad coverage for behavioral health, but specifics vary.
- Eligible providers often include licensed psychologists, social workers, and psychiatrists—but confirm per state plan.
- Some state Medicaid programs allow asynchronous and audio-only services under limited conditions.
Reference: Medicaid telehealth guidance—https://www.medicaid.gov/medicaid/benefits/telehealth/index.html
Billing examples and common Medicaid claim edits
Sample claim line for an individual psychotherapy teletherapy session:
- Date: 2025-01-15
- CPT: 90834
- Modifier: 95
- POS: 02 (if required by the state)
- Units: 1
- Diagnosis: F32.1
Common Medicaid edits:
- Denial for missing modifier or incorrect POS.
- Denial when provider is not enrolled as a telehealth provider in the state Medicaid system.
- Denial for audio-only services when the state requires audio-video.
Troubleshooting steps:
- Check the state Medicaid provider manual.
- Correctly submit provider enrollment and telehealth addenda.
- If audio-only is used, document why audio-video was clinically inappropriate or technically unavailable (when policy allows).
Strategies for staying compliant with Medicaid and maximizing reimbursement
- Enroll promptly with state Medicaid and verify telehealth addenda.
- Maintain up-to-date provider rosters and credential documentation.
- Track timely filing deadlines—Medicaid agencies often have strict windows.
- Keep state policy links and change logs; assign staff to monitor updates.
- Use coding and documentation templates aligned with state Medicaid requirements.
Claims Submission, Denials, and Practical Tips to Get Paid
Best practices for claim submission: EHR, clearinghouse, and coding checks
- Integrate EHR templates with required telehealth fields (consent, start/stop times, technology attestation).
- Use a clearinghouse with pre-adjudication edits to catch common errors (missing modifier, invalid CPT/POS combos).
- Pre-file audits: spot-check a percentage of telehealth claims weekly.
- Use numeric crosswalks and code pair checks to prevent incompatible code pairings.
Handling denials: appeal structure and documentation to resubmit
Common denial reasons:
- Not covered (service excluded for telehealth)
- Incorrect modifier or POS
- Insufficient documentation / lack of medical necessity
- Provider not enrolled for telehealth
Appeal structure:
- Identify denial reason and gather payer policy that supports your position.
- Collect contemporaneous clinical notes, treatment plan, consent, and attendance rosters (for group).
- Submit an appeal letter referencing policy, claim details, and enclosed documentation.
- Track response timelines and escalate to provider relations if needed.
Teletherapy reimbursement tips for clinicians: operational and clinical shortcuts
Operational shortcuts:
- Use checklists at intake: consent, tech test, insurance verification, prior auth.
- Batch authorization and eligibility checks weekly.
- Use templates for progress notes tied to each CPT code’s documentation expectations.
Clinical shortcuts:
- Document succinctly but with necessary detail: focused objectives, interventions used, and measurable progress.
- For timed codes, use discrete start/stop timestamps and calculate total face-to-face time.
Practical scripts for payer calls:
- “Hello, I am calling about patient [Name], DOB [MM/DD/YYYY]; we rendered CPT [code] on [date] via synchronous audio-video. Can you confirm whether your policy requires modifier 95 and POS 02, or do you prefer POS 11 with modifier 95?”
Conclusion: Putting It Together — A Practical Action Plan for 2025
5 immediate actions to implement this week
- Update your EHR telehealth note template to include consent, tech modality attestation, and start/stop times.
- Create a payer quick-reference sheet listing each payer’s modifier and POS preference.
- Run a 30-day pre-billing audit of telehealth claims to catch missing modifiers and consent issues.
- Confirm provider enrollment for Medicaid telehealth and revalidate credentials where required.
- Prepare a standard appeals packet (clinical notes, treatment plan, attendance rosters) and one-click export for denied claims.
Resources and checklists to save and share (including private payer teletherapy coverage checklist)
- CMS Telehealth: https://www.cms.gov/medicare/telehealth
- Medicaid telehealth resources: https://www.medicaid.gov/medicaid/benefits/telehealth/index.html
- AMA telehealth CPT guidance: https://www.ama-assn.org/practice-management/digital/telehealth-cpt-codes
- Practical checklist (save this list):
- Verify patient eligibility for teletherapy
- Confirm payer-specific modifier/POS rules
- Obtain and document telehealth consent
- Use timed start/stop for psychotherapy codes
- Maintain group session attendance rosters
- Keep provider Medicaid enrollment current
Final notes on monitoring updates and staying prepared for future policy shifts
Telehealth policy continues to evolve. Assign a point person to monitor CMS, state Medicaid bulletins, and major private payer updates monthly. Keep clinical and billing staff trained on documentation requirements and maintain an internal audit rhythm to reduce denials.
Teletherapy is here to stay—accurate coding, robust documentation, and proactive payer management are your best defenses against denials and delayed payments.
Call to action: Start with the five immediate actions this week and schedule a 30-minute team training to implement the documentation templates and payer quick-reference sheet.
Sources and further reading:
- CMS. Telehealth Services. https://www.cms.gov/medicare/telehealth
- Medicaid.gov. Telehealth in Medicaid. https://www.medicaid.gov/medicaid/benefits/telehealth/index.html
- American Medical Association. Telehealth CPT Codes. https://www.ama-assn.org/practice-management/digital/telehealth-cpt-codes
- McKinsey & Company. “Telehealth: A quarter-trillion-dollar post-COVID-19 reality?” (analysis of telehealth adoption trends). https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/what-now-for-telehealth
Thank you — use the private payer teletherapy coverage checklist above and implement the five immediate actions this week to reduce denials and improve cash flow for your teletherapy services in 2025.
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