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Telehealth has made it possible for practices to treat patients almost anywhere. It’s convenient, flexible, and something patients rely on now more than ever. But once you start offering care across state lines, the billing side becomes a whole different story. What works perfectly fine in your home state suddenly doesn’t apply somewhere else. Claims get held, documentation rules change, and payer requirements shift faster than anyone expects. If your practice is already offering multi-state telehealth or is thinking about expanding into new states, it’s important to understand the specific challenges that come with it. Not because the process is impossible, but because being aware of the differences helps you avoid the delays and denials that frustrate so many providers. 1. State Telehealth Rules Don’t Match One of the biggest roadblocks is the fact that every state plays by its own rules. Some states treat telehealth almost the same as in-person care, while others set stricter boundaries on what counts as a covered telehealth service. Something as small as whether audio-only visits are allowed can make or break a claim. And if you use one uniform billing approach for patients in different states, you’ll run into problems faster than expected. The best way to handle this is by having a simple way to confirm each state’s telehealth guidelines. Not a giant document that overwhelms your team, but just clear information your billers and providers can quickly refer to, so no one is guessing what a specific state or payer expects. 2. Licensing and Credentialing Slow Billing Down More Than People Realize Many practices don’t realize how much licensing impacts billing until claims start getting denied. Telehealth doesn’t mean a provider can automatically treat a patient in any state. The provider must be licensed there, and they must be fully credentialed with that state’s payers. If they see patients before everything is approved, billing becomes a mess. Claims don’t just get delayed; they often get denied outright. A smooth system for tracking licensing and payer enrollment becomes essential once you work across multiple states. Keeping everyone aligned, like providers, credentialing staff, and billing teams, prevents accidental billing before approval and protects the practice from long reimbursement delays. 3. Payer Rules Shift From State to State Even when you’re dealing with one national payer like Aetna or Blue Cross, their telehealth rules don’t stay consistent across states. One state may require modifier 95, while another sticks to GT. Some want POS 02, some prefer POS 10. And if billing teams aren’t working off state-specific guidance, errors are almost guaranteed. It helps to treat each payer differently based on the state you’re billing for. When your team knows the exact code and modifier combination needed for that state, claims move without back-and-forth corrections. 4. Documentation Requirements Aren’t Universal Telehealth documentation is stricter than a lot of practices expect, and the rules vary by state. Some states want you to clearly note where the patient was during the call, while others want the provider’s location as well. Some want the length of the visit recorded, or whether it was video versus audio-only. Leave out even one detail, and you risk a denial later, sometimes during an audit rather than upfront, which is even harder to clean up. A consistent approach to documentation helps prevent that. When providers follow the same telehealth note structure across all states, you don’t end up rewriting notes or defending documentation months after the visit happened. 5. Payment Rates Don’t Line Up Across States Reimbursement rates for telehealth can vary widely from one state to another. Some follow Medicare’s rates. Some follow parity laws, meaning telehealth gets paid the same as in-person care. Others pay less, and a few pay more for certain telehealth services. If you assume all states pay the same, you’ll end up confused about underpayments or overpayments. Monitoring state-level fee schedules, only for the payers you bill frequently, helps you stay ahead of payment discrepancies. It doesn’t need to be complicated; it just helps you understand what should be coming in. 6. Denials Increase When You Apply the Wrong State Rules Most denials in multi-state telehealth billing aren’t due to complicated coding mistakes. They’re caused by small, avoidable errors like using the wrong modifier, sending claims before credentialing is complete, or submitting a telehealth service that isn’t covered in that particular state. These errors build up quickly, especially if your practice expands into several states at once. A good approach is to review denial patterns regularly. If you notice the same denial reason repeating for one state, that’s a sign that something in your workflow needs to be updated. The fix is usually simpler than it seems. 7. Compliance Gets Harder As You Expand The more states you serve, the more rules you’re responsible for following. That includes licensing laws, payer updates, telehealth regulations, and documentation guidelines. None of these stays the same forever. States adjust their policies, payers refine their requirements, and what worked last year might not work now. To stay compliant, you don’t need a huge legal team or a complicated system. What you do need is someone keeping an eye on regulatory updates, ideally on a monthly or quarterly basis. Even quick high-level checks help your practice stay ahead of changes. 8. Front-Office Workflows Aren’t Built for Multi-State Telehealth Scheduling telehealth across multiple states creates new tasks for your front-desk team. They suddenly need to confirm patient location, check the provider’s eligibility for that state, and make sure the payer covers telehealth for that specific service. When these details aren’t confirmed before the visit, billing problems show up afterward. Smooth workflows don’t need to be long or complicated. What matters is that staff know exactly what to verify before the visit begins. When the basics are checked up front, the billing cycle becomes much more predictable. Final Thoughts Multi-state telehealth billing isn’t just “telehealth with extra steps.” It comes with its own rules, challenges, and expectations that change from one state

If you’re like most doctors, you’ve probably stared at your EHR screen at the end of a long day, wondering if your telehealth notes are complete or if that one missing detail could cost you a claim. Telehealth isn’t new anymore, but the rules keep shifting. New CPT codes, updated documentation requirements, and temporary policy changes make billing feel like walking on a tightrope. One slip, and claims get denied. This guide breaks it down simply. By the end, you’ll know exactly what to document, which codes to use, and how to keep your telehealth billing smooth and compliant in 2025. Why Documentation Can’t Be Skipped Let’s get real: just because the patient is on a video call doesn’t mean the rules for documentation go away. In fact, thorough records are more important than ever. They protect your practice, justify your billing, and make audits far less stressful. Here’s what you need for every telehealth visit: Yes, it looks like a lot, but these aren’t arbitrary boxes to tick. Payers, including Medicare, require them to be explicitly documented. That includes the technology used and, in some cases, why telemedicine was chosen over an in-person visit. For mental health or behavioral health visits, audio-only is still allowed as long as the patient’s home is listed as the site of care. CMS has made this permanent, recognizing that not all patients have reliable video access but still need care. Some federal rules have been temporarily loosened, too. Telehealth is allowed for hospice recertification, acute hospital care at home, and follow-up visits in inpatient or nursing facilities through September 30, 2025. These flexibilities are meant to keep patients safe while allowing you to provide care remotely. CPT Codes You Need to Know CPT codes are the backbone of any billing process. For telehealth, 2025 brings some big updates. Codes 98000–98007 now cover synchronous (live) audio-video telemedicine visits. They mirror the in-person E/M rules, meaning you pick a code based on Medical Decision Making (MDM) or total time spent with the patient. Here’s a quick guide for new patients: For extended visits, you can use add-on code 99417 for non-Medicare patients or G2212 for Medicare. Established patients have their own set: 98008–98011 and 98012–98015, covering audio-only and audio-video visits. The old telephone codes 99441–99443 are gone, replaced by these telemedicine-specific codes. If your templates haven’t been updated, now’s the time. Modifiers and Place of Service Modifiers are simpler than they used to be. Most telehealth codes now include the delivery mode, so Modifier 95 for video and Modifier 93 for audio-only are rarely required. Medicare may still ask for them in some scenarios, but most commercial payers don’t. Place of Service codes matter for payment: Other niche modifiers, like GT for Critical Access Hospitals or GQ for asynchronous federal projects, may come up in rare cases. It’s worth knowing when these apply so your claims don’t get held up. Simple Best Practices Billing doesn’t have to be a nightmare. A few habits can save you headaches and money: Doing these things consistently will make telemedicine billing changes much less daunting and help you get reimbursed on time. Common Mistakes to Avoid Even senior physicians commit minor yet expensive mistakes. The most frequent ones are the following: These errors are simple to avoid, provided that you have a habit of going through each note and claim prior to submission. Consider it a mini-audit whenever you are closing a telehealth visit. Why Staying Updated Matters Telehealth​‍​‌‍​‍‌ is here to stay. It’s gradually becoming a fixed part of the medical system. Regulations and payment conditions will continue to change, but practices that are up-to-date will reap the benefits. Having your records precise, applying the correct codes, and being familiar with the payer’s rules will maintain the claims at a steady flow and lessen the worries. With alterations in telemedicine billing coming in 2025, it is really possible to do it correctly. Doing the right things now will result in an easier claims process, fewer rejections, and less time spent on obtaining ​‍​‌‍​‍‌payments. Key Takeaways There is no need for telehealth billing to be very confusing. Just keep your codes updated, your documentation tight, and watch for any changes in the policy. When you do these things, billing becomes something you can handle, is in compliance, and is even predictable. By being up to date with the information, you are able to concentrate on what is most important, giving care, even if your patients are not in the same ​‍​‌‍​‍‌room.