Billing and collections for virtual-first, hybrid, tele-behavioral health and remote monitoring practices, done inside the EHR and video platform you already use.
Telemedicine revenue leaks at the claim line, not on the video call. Medicare wants POS 10 for a patient at home, Cigna asks for POS 02 plus 95, GT or GQ, and Ohio Medicaid wants GT with the clinician's location. Audio-only visits were billed with video modifiers on 6% of telehealth claims in the Luxen claim audit, and on October 1, 2026, RHCs and FQHCs stop billing G2025. Luxen matches every virtual visit to each payer's rules before it goes out.
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Telemedicine billing services code, submit and follow up claims for video, audio-only, e-visit and remote monitoring care, matching place of service, modifiers and codes to each payer. Medicare pays POS 10 home visits at the non-facility rate. Audio-only visits were billed with video modifiers on 6% of telehealth claims in the Luxen claim audit.
Each type of virtual practice bills differently.
We also bill e-visits, virtual check-ins and originating site fees (Q3014).
Our eligibility and benefits checks confirm telehealth coverage first. Dollar figures are 2026 CMS amounts.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Medicare patient seen at home | 99212 to 99215 with POS 02 | Paid the facility rate, not the POS 10 non-facility rate | The rate difference on every visit | POS checked against documented patient location |
| Patient declines video | E/M code with modifier 93 | Billed as video, or sent to a plan that excludes audio-only | Full visit, plus recoupment on audit | Audio-only visits were billed with video modifiers on 6% of telehealth claims |
| One claim format for every payer | POS 02, POS 10, modifiers 95 and GT | Medicaid or commercial plan rejects the Medicare format | Full visit | Coding and modifier errors caused 21% of denials |
| Patient located in another state | Any telehealth service | Clinician not licensed or enrolled where the patient sits | Full visit | Credentialing lapses delayed payment for 1 in 12 providers added in the prior year |
| RHC or FQHC visit on or after October 1, 2026 | Individual code with 93 or 95, not G2025 | G2025 still billed after the switch | $97.53, the 2026 G2025 rate | Date of service checked before release |
| Patient at your clinic, clinician remote | Q3014 | Originating site fee never billed | $31.85 per visit in 2026 | Site fees matched to distant site visits |
Medicare identifies telehealth by place of service, not a separate visit code: office E/M codes 99202 to 99215 stay the same. Our certified medical coding team sets POS and modifier rules per payer.
| POS | CMS description | Medicare payment |
|---|---|---|
| 02 | Telehealth provided other than in patient's home | Facility rate |
| 10 | Telehealth provided in patient's home | Non-facility rate |
| Modifier | Meaning | Medicare use |
|---|---|---|
| 93 | Real-time audio-only | Patient at home declines video; non-behavioral through 2027, behavioral permanent |
| 95 | Synchronous audio-video | Hospital-based clinician, patient at home; hospital outpatient therapy; RHC and FQHC from October 1, 2026 |
| FQ | Audio-only telehealth | RHC and FQHC claims |
| FR | Supervising practitioner present by audio-video | Virtual direct supervision |
| GT | Interactive audio-video | CAH optional payment Method II institutional claims |
| GQ | Asynchronous telecommunication | Alaska and Hawaii federal demonstration project |
CPT added 98000 to 98015 in 2025 and deleted telephone codes 99441 to 99443. Medicare adopted neither change, so Medicare telehealth still bills 99202 to 99215. Commercial and Medicare Advantage adoption varies.
| Code | Service | Billing rule |
|---|---|---|
| 98016 | Virtual check-in, 5 to 10 minutes; replaced G2012 | Not tied to a visit in the prior 7 days or next 24 hours |
| G2252 | Virtual check-in, 11 to 20 minutes | Same 7-day and 24-hour rule |
| 99421 to 99423 | E-visit, 5 to 10, 11 to 20 or 21+ minutes over 7 days | Patient-initiated |
| 99454, 99445 | RPM data: 16 or more days, or 2 to 15 days, per 30 days | Never bill 99445 with 99454 |
| 99457, 99470 | RPM management: first 20 minutes, or first 10 minutes | One practitioner per patient per 30 days; not with RTM |
The Consolidated Appropriations Act, 2026 (Public Law 119-75), signed February 3, 2026, extended Medicare telehealth flexibilities through December 31, 2027, after a lapse from October 1 to November 12, 2025 in which MACs held and returned claims.
Behavioral health telehealth from home, including audio-only, plus substance use disorder treatment, home dialysis ESRD assessments and acute stroke.
G2025 paid $97.53 in 2026. For dates of service on or after October 1, 2026, RHCs and FQHCs bill the individual CPT or HCPCS code with modifier 93 or 95 on type of bill 71X or 77X. Mental health visits stay under the AIR and PPS.
The Ryan Haight Act requires an in-person evaluation before prescribing controlled substances. The DEA's fourth temporary extension waives it through December 31, 2026; the special registration final rule is still under OMB review.
Commercial plans and Medicaid programs publish their own POS and modifier rules, and 44 states, DC, Puerto Rico and the Virgin Islands have laws on private payer telehealth reimbursement.
| Payer policy | POS | Modifier | Audio-only |
|---|---|---|---|
| UnitedHealthcare commercial, policy 2026R0046A | 02 or 10 | 95, GT, GQ and G0 not required, accepted as informational | Appendix T codes with 93 and POS 02 or 10 |
| Cigna virtual care guidance | 02; asks that 10 not be billed | 95, GT or GQ required | Asks that 93 and FQ not be billed |
Only 24 states and Puerto Rico have telehealth payment parity requirements. Kansas lets payers set rates as they would in person, but the medical record satisfies all telemedicine documentation. Nebraska requires in-person rates only when the provider also practices at a physical Nebraska location or holds privileges at a Nebraska facility. Louisiana sets a floor of 75% of an intermediate office visit for the physician at the originating site. Underpayments against contracted rates appeared on 7.8% of paid claims (Luxen claim audit).
A physician must be licensed where the patient is located and enrolled with that plan. The Interstate Medical Licensure Compact (44 member states) speeds licensing, not payer enrollment. Our credentialing team tracks both by patient state.
Medicare pays POS 10 visits for patients at home at the non-facility rate and POS 02 visits at the facility rate (CMS telehealth FAQ). Only 24 states and Puerto Rico require commercial payment parity (CCHP 2025 policy summary). The average underpaid claim was short by $38 (Luxen claim audit).
For Medicare, POS 02 or 10 identifies telehealth; modifier 95 is for hospital-based clinicians and hospital outpatient therapy (Noridian telehealth guidance), plus RHC and FQHC claims from October 1, 2026 (CMS MM14468). Ohio Medicaid requires GT in most cases (Ohio Medicaid guidelines). Coding and modifier errors caused 21% of denials (Luxen claim audit).
CPT deleted 99441 to 99443 on January 1, 2025, and CMS did not replace them (Noridian telehealth E/M update). Medicare audio-only visits bill the E/M code with modifier 93, yet audio-only visits were billed with video modifiers on 6% of telehealth claims (Luxen claim audit).
A physician must be licensed by the medical board of the state where the patient is located (FSMB telemedicine policy), and each plan must enroll the clinician. Credentialing lapses delayed payment for 1 in 12 providers added in the prior year (Luxen billing reviews).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the systems your clinicians already use, with no migration.
We sign the BAA before access.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
Our team was using the same place-of-service and modifier combination for every virtual visit, regardless of payer. Luxen mapped the correct workflow, reduced telemedicine rejections from 14.2% to 3.1%, and recovered $41,900.
Revenue Cycle Director, multispecialty telemedicine practice
Completed virtual appointments did not always create a billing task in the EHR. Luxen reconciled the telemedicine schedule against signed notes, captured 326 missed encounters, and added $27,400 in monthly collections.
Chief Operating Officer, virtual primary care group
Full engagements are written up in our dental practice case study and our ambulance billing case study.
| KPI | Why it matters in telemedicine | Luxen benchmark |
|---|---|---|
| Audio-only modifier accuracy | Audio-only and video visits pay and audit differently | Audio-only visits were billed with video modifiers on 6% of telehealth claims |
| Eligibility denials | Plans differ on telehealth benefits and carve-outs | Eligibility and coverage errors caused 24% of denials |
| Denials never worked | Low-dollar virtual visits get written off | 19% of denied claims were never reworked or appealed |
The HHS Office of Inspector General found Medicare remote patient monitoring payments exceeded $500 million in 2024 (OEI-02-23-00261), and that 43% of RPM enrollees did not receive all 3 components of monitoring (OEI-02-23-00260). Our denial and AR recovery team reports these KPIs monthly by payer and visit type.
The 2026 Part B deductible is $283, and after it the patient pays 20% of the Medicare-approved amount for telehealth. OIG protection for waiving telehealth cost sharing ended May 11, 2023.
Self-pay patients scheduling at least 3 business days ahead get a written Good Faith Estimate within 1 business day. The rule covers telemedicine, and a bill at least $400 above the estimate can be disputed.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Video and audio-only visits | $85,000 | $2,550 | $5,100 |
| Remote physiologic and therapeutic monitoring | $25,000 | $750 | $1,500 |
| E-visits, virtual check-ins and originating site fees | $10,000 | $300 | $600 |
| Total | $120,000 | $3,600 | $7,200 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $9,480 (7.9% of collections) | $3,600 to $7,200 |
| Annual | $113,760 | $43,200 to $86,400 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews).
| Partner type | Payer rule depth | Remote monitoring | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Tracked by hand | Built by staff | Payroll and turnover |
| Generalist billing company | Medicare format for every payer | Often excluded | Standard aging | Often annual |
| Specialty billing company | Payer-specific rules | Sometimes extra fee | Varies | Varies |
| EHR vendor RCM | Vendor claim rules | Vendor devices only | Vendor platform | Bundled with software |
| Luxen | Certified coders map POS and modifiers per payer | RPM and RTM included | Monthly denials and AR by payer | Month to month, 30 days notice |
Compare medical billing companies on these points, or see what full-service medical billing covers.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
For Medicare, usually neither: POS 02 or 10 identifies telehealth, GT is only for critical access hospital Method II claims, and 95 is for hospital-based clinicians and RHC or FQHC claims from October 1, 2026. Cigna's virtual care guidance requires 95, GT or GQ, and Ohio Medicaid requires GT in most cases.
Luxen charges 3% to 6% of collections, depending on visit volume, payer mix and remote monitoring work. For a virtual practice collecting $120,000 a month, that is $3,600 to $7,200. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in Luxen billing reviews.
About 2 weeks; median time from signed BAA to first claims worked was 9 business days across Luxen clients. We start with open POS and modifier denials, so first recovered payments arrive in about 3 weeks. No migration, setup fee or exit fee.
Yes. We work inside the EHR you already use, including athenaOne, eClinicalWorks, Epic, SimplePractice and TherapyNotes, and clinicians keep their video platform. We sign a BAA before access.
For Medicare, yes, when the clinician can use video but the patient cannot or does not consent: bill 99213 with modifier 93 and POS 10 for a patient at home. That applies to non-behavioral care through December 31, 2027 and permanently to behavioral health. Medicare did not adopt audio-only codes 98008 to 98015.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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