Telehealth Billing Codes 2026: Complete Guide to Modifiers, POS Codes & CPT Codes

Telehealth billing is one of the fastest-moving areas in medical revenue cycle management. Since the COVID-19 public health emergency (PHE) ended in May 2023, providers have had to navigate a patchwork of temporary extensions, permanent policy changes, and payer-specific rules that vary wildly — sometimes even within the same insurance company across different states.

This guide cuts through the confusion. Whether you are billing Medicare, a state Medicaid program, or a commercial payer, you will find the exact modifier, Place of Service code, and CPT code you need — plus the documentation requirements to protect against denials.

Use the free Telehealth Billing Code Checker above to get instant, payer-specific answers for your specific situation. The guide below explains the reasoning behind every result the tool produces.

What is telehealth billing and why does it matter in 2026?

Telehealth billing refers to the process of submitting insurance claims for medical services delivered remotely — via video, telephone, or secure patient portal — rather than in person. The claim process itself is largely the same as in-person billing, but requires specific modifiers, Place of Service codes, and sometimes entirely different CPT codes depending on the payer and service type.

In 2026, telehealth billing matters more than ever for three reasons:

• Medicare coverage is extended, not permanent. Congress extended telehealth flexibilities through December 31, 2027 via the Consolidated Appropriations Act (CAA). Without another extension, many flexibilities revert after that date. Providers billing telehealth need to track these deadlines.
• Payer policies have diverged significantly post-PHE. What Medicare covers does not automatically apply to commercial payers or state Medicaid programs. Each payer has developed its own telehealth policy, creating a complex, fragmented billing landscape.
• Telehealth claim denials are rising. According to industry data, telehealth claims are denied at a significantly higher rate than in-person claims — primarily due to incorrect modifiers, wrong POS codes, missing documentation, and services not on a payer’s covered telehealth code list.

Telehealth modifiers explained: 95, 93, and GT

Modifiers are two-digit codes appended to CPT codes on a claim to provide additional context about how or where a service was delivered. For telehealth, three modifiers are in active use in 2026:

Modifier 95: the standard audio-video telehealth modifier

Modifier 95 is the primary telehealth modifier recognized by CMS, the AMA, and the majority of commercial payers. It tells the payer that the billed service was delivered via a real-time, two-way audio-video connection — such as Zoom for Healthcare, Doxy.me, or an EHR-integrated telehealth platform like Epic MyChart. Modifier 95 should never be used for telephone-only visits.

Modifier 93: audio-only telehealth

Modifier 93 was introduced by the AMA in 2022 to create a distinct billing pathway for telephone-only services. Under Medicare, modifier 93 is covered only when the patient lacks video capability or explicitly declines video — and you must document the specific reason. It cannot be used as a routine alternative to modifier 95 simply because it is more convenient. Under UHC, modifier 93 is only permitted on CPT codes specifically listed in CPT Appendix T.

Modifier GT: the legacy modifier

Modifier GT predates the 95/93 system and is still required by approximately 19 state Medicaid programs as of 2026. Using modifier 95 on a claim for a state that requires GT will result in an automatic denial. States including Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wyoming still require modifier GT. Use the payer search tool above to identify which modifier your specific state Medicaid program requires.

Place of Service codes for telehealth: POS 02 vs. POS 10

Place of Service (POS) codes tell the payer where the patient was physically located when they received the service. For telehealth, two POS codes are relevant:

CMS introduced POS 10 in January 2022 specifically to reflect the shift toward patients receiving telehealth from home. The distinction matters because Medicare pays differently for home vs. non-home telehealth in some situations. Most commercial payers have adopted the same POS 02/10 framework, though Aetna commercial is a notable exception — Aetna does not restrict POS codes for telehealth claims and accepts any POS code.

CPT codes for telehealth visits in 2026

The CPT codes used for telehealth depend on the type of service. The table below covers the most commonly billed telehealth codes in 2026:

Medicare telehealth coverage in 2026

Medicare remains the most important payer to understand for telehealth billing. The Consolidated Appropriations Act (CAA) extended Medicare telehealth flexibilities through December 31, 2027. Key Medicare telehealth coverage facts for 2026:

• Audio-video E/M visits (99202–99215 with modifier 95) are fully covered from the patient’s home (POS 10) or other locations (POS 02).
• Audio-only E/M visits (99202–99215 with modifier 93) are covered only when the patient lacks video capability or explicitly declines video. The specific reason must be documented in the medical record.
• Mental health telehealth is covered, but Medicare requires a documented in-person visit within 6 months of initiating mental health telehealth services, and annually thereafter. Missing this documentation is the number-one cause of mental health telehealth claim denials under Medicare.
• Virtual check-ins (98016) are covered for established patients only. The check-in must be patient-initiated and must not relate to a visit within 7 days or lead to a visit within 24 hours.
• E-visits (99421–99423) are covered for established patients communicating via a secure HIPAA-compliant portal.
• Railroad Medicare (administered by Palmetto GBA) mirrors Medicare Part B telehealth rules exactly.

State Medicaid telehealth: how policies differ

No two state Medicaid programs handle telehealth identically. The differences fall into three main categories:

1. Modifier requirement: GT vs. 95

Approximately half of state Medicaid programs have aligned with CMS and now require modifier 95 for audio-video telehealth. The other half still require the legacy modifier GT. A small number accept both. The tool above automatically identifies which modifier your state requires.

2. Audio-only coverage

This is where state Medicaid policies diverge most dramatically. Some states — including California (Medi-Cal), Washington (Apple Health), New York, Illinois, Massachusetts, and Oregon — have permanently and broadly authorized audio-only telehealth for all covered services under state law. Others, like Texas (SB 670), Mississippi, South Dakota, and Wyoming, do not broadly cover audio-only E/M and restrict telephone visits primarily or entirely to mental health services.

3. Prior authorization for telehealth

Some state Medicaid programs require prior authorization for specific telehealth service types — particularly remote patient monitoring (RPM). Always verify PA requirements for your state before initiating an RPM program.

For the complete list of all 50 states + DC, use the payer search in the billing code checker above and select your specific state Medicaid program.

Commercial payer telehealth policies

Commercial payers have diverged significantly from Medicare in their telehealth policies since the PHE ended. Here are the key distinctions for the major national payers:

UnitedHealthcare (UHC)

UHC follows Medicare telehealth policy for most plans. However, for audio-only visits, UHC does not allow modifier 93 on standard 992XX E/M codes. Instead, you must use telephone E/M codes 99441–99443 for audio-only visits where covered. UHC only allows modifier 93 on codes specifically listed in CPT Appendix T.

Aetna (Commercial)

Aetna commercial does not cover audio-only E/M visits at all — claims submitted with modifier 93 for audio-only E/M will be denied. Aetna is notably adopting the new AMA 98000-series telehealth codes for commercial plans and does not restrict POS codes, accepting any POS on telehealth claims.

Cigna

Cigna restricts audio-only reimbursement to behavioral health and specific chronic disease management scenarios. Billed CPT codes must appear on Cigna’s eligible virtual care code list. Cigna does broadly cover audio-only behavioral health telehealth with modifier 93 — one of the few categories where it allows audio-only broadly.

BCBS and Anthem

Both Anthem BCBS and local BCBS plans generally follow Medicare telehealth policy with modifier 95 for audio-video. Audio-only mental health is broadly covered, but general E/M audio-only varies significantly by state plan. Horizon BCBS (NJ) explicitly covers audio-only with modifier 93.

Audio-only telehealth billing: what you need to know

Audio-only telehealth (telephone visits) is the most contentious area of telehealth billing in 2026. The fundamental rules are:

• Under Medicare: Audio-only is covered with modifier 93, but only when the patient lacks video capability or explicitly declines video. You must document the specific reason in the chart — a blanket statement like “patient prefers phone” is insufficient and will not survive an audit.
• Under most commercial payers: Audio-only E/M coverage is limited or unavailable for general medical visits. It is more broadly available for mental and behavioral health services.
• Under state Medicaid: Coverage ranges from comprehensive (California, Washington, New York) to completely unavailable for E/M (Texas, Mississippi, Wyoming). Verify before billing.

When audio-only is not covered for E/M, consider whether the patient qualifies for a virtual check-in (98016) instead — which is covered audio-only under Medicare and most major payers.

Documentation requirements for telehealth claims

Telehealth claims fail audits and post-payment reviews when documentation is incomplete. The following elements must be in the medical record for every telehealth claim:

1. Patient verbal consent for telehealth, documented in the chart (most payers require this for every visit, not just the first)
2. Provider’s physical location — city and state — at the time of service
3. Patient’s physical location — city and state — at the time of service (this determines the correct POS code)
4. Technology used — confirm the platform is HIPAA-compliant (e.g., Zoom for Healthcare, Doxy.me, Teladoc, Epic MyChart) and that it was two-way, real-time audio-video for modifier 95 visits
5. For modifier 93 visits: the specific documented reason video was not used
6. Clinical documentation supporting medical necessity and the level of service billed — this is the same standard as in-person visits
7. For Medicare mental health telehealth: the date of the most recent in-person visit (required within 6 months of initiation and annually)

Common telehealth claim denials and how to prevent them

For a comprehensive denial resolution guide, visit our Denial Code Lookup tool, which covers all CARC codes with specific resolution steps. You can also use our Revenue Leakage Calculator to estimate how much telehealth billing errors are costing your practice each month.