Telehealth Billing Updates: What You Need to Know for 2025

Several changes to telehealth billing and reimbursement policies are coming into effect in 2025, impacting healthcare providers. Here’s a summary of key updates:

1. Telehealth CPT Codes (98000–98016)

• Blue Cross and Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN): Will reimburse CPT codes 98000–98011 beginning January 1, 2025.
• Priority Health: Will reimburse CPT codes 98000–98016 for commercial plans but not for Medicare plans. Medicaid guidance is pending. Additional Priority Health billing guidance can be found here.
• Medicare and Health Alliance Plan (HAP): Only CPT code 98016 is valid for reimbursement. Other codes (98000–98015) are invalid. For audio-only services, use standard E/M codes with modifier “93.”

2. Guidance for Unrecognized CPT Codes

Since the Centers for Medicare & Medicaid Services (CMS) does not recognize the new CPT Telemedicine Services codes, CMS directs physicians to refer to the list of telehealth services for Calendar Year 2025 and choose the most appropriate code for the service rendered.

3. Extension of Telehealth Flexibilities

The American Relief Act of 2025 extended waivers on geographic, site-of-service, and practitioner-type restrictions through March 31, 2025. This means Medicare patients in non-rural areas and those accessing telehealth from home can continue receiving services without additional barriers.

It is crucial for providers to review payer-specific policies and confirm billing practices with each insurer, as telehealth coverage and reimbursement can vary significantly between Medicare, Medicaid, and commercial payers. Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.