Telehealth claims are rejected more often for coding mismatches than for clinical reasons. This quick reference covers the items that most often cause trouble, so you can check them before you submit. Payer rules change every year, so treat this as a checklist and confirm against each payer’s current policy.
Modifiers
Many payers want a modifier showing that the visit was delivered by telehealth. Modifier 95 is commonly used for real-time audio and video visits, and modifier 93 is commonly used for audio-only visits. Some payers require different modifiers or none at all, so check each contract.
Place of service
The place-of-service code tells the payer where the client was. Codes 02 and 10 are used for telehealth, depending on whether the client was at home or elsewhere. Using the wrong one is a frequent reason for a denial or a lower payment.
Documentation
Note in each record that the visit was delivered by telehealth, the client’s location, and the technology used. Those details make an appeal much easier if a claim is questioned.
Keep a one-page cheat sheet for each payer and update it every January.