Telehealth / Virtual Therapy Billing Challenges

Telehealth has changed the way mental health and behavioral health providers deliver care. With virtual therapy sessions now a common part of treatment, patients have easier access than ever before. But for providers, telehealth billing comes with unique challenges that, if not handled correctly, can quickly disrupt revenue flow.

Here are the most common issues I see practices struggling with:

1. Payer Variability
   

   Not all insurance carriers handle telehealth the same way. Some require specific modifiers (95, GT, FQ/FR), while others need different place-of-service codes. Even small errors — like using the wrong modifier — can cause claim rejections or underpayments.

   Solution: Keep updated payer-specific billing guidelines and train staff to apply the right codes consistently.

2. Documentation Gaps
   

   Telehealth visits must be documented with the same level of detail as in-person sessions. Missing elements such as time stamps, consent, or clinical notes are common reasons claims get denied.

   Solution: Standardize your documentation process for telehealth and audit regularly to catch gaps before submission.

3. Credentialing for Telehealth
   

   Some states and payers require providers to be credentialed separately for telehealth services. Many practices overlook this step, which delays payments for months.

   Solution: Verify credentialing requirements before offering telehealth visits to patients and ensure your providers are fully compliant.

4. Modifier Confusion
   

   Billing modifiers are at the core of telehealth claims, but payers differ in their requirements. For example, while Modifier 95 is commonly used, some payers still expect GT, and others mandate FQ/FR for specific encounters.

   Solution: Build a payer matrix that outlines the correct modifiers for each insurer.

5. Evolving Regulations
   

   During the COVID-19 pandemic, many telehealth policies were relaxed, but those rules continue to change. Some waivers have expired, while others remain in effect. Providers who don’t stay current risk denied claims.

   Solution: Regularly review CMS updates and payer bulletins, or work with billing specialists who track regulatory changes.

Final Thoughts

Telehealth is here to stay, but billing complexities shouldn’t prevent practices from being paid fairly and on time. The key is accurate coding, proper documentation, and staying ahead of changing regulations.

At Novasphere Billing, we specialize in helping mental health providers simplify telehealth billing. From credentialing to claim submission and collections, our team ensures your practice gets reimbursed without unnecessary delays.

💡 Would you like us to review one of your telehealth claims for free? Reach out today to see if you’re missing revenue opportunities.