You need a scorecard to track telehealth coverage in 2025 (Update 3/3/25)

You know that CMS will not reimburse the new CPT telehealth codes (PBN 1/23/24, subscription required). However, some commercial plans are picking up the new codes (98000-98015).

 

If your practice provides telehealth services in place of office/other outpatient E/M visits you will need to research each plan, write up your findings and communicate them to relevant members of your team. 

 

Remember to note whether the plan covers audio/video services (98000-98007), audio-only services (98008-98015) or both, plus any place of service and modifier requirements. Finally, make sure you’re signed up to receive policy updates from each plan to stay on top of changes.

 

A quick check of several commerical payers revealed a variety of policies (see the telehealth coverage scorecard below). 

 

The following plans accept telehealth codes 98000-98015:

The following plans do not accept the new codes and instruct providers to stick with the office/outpatient codes for telehealth services:

Finally, Blue Cross/Blue Shield South Carolina (BCBSSC) only covers the audio/video codes.

 

Help PBN build a complete telehealth coding scorecard for commercial plans. Share your commercial payers' telehealth coverage policies with links in the comments section and we’ll update the scorecard.