You know that CMS will not reimburse the new CPT telehealth codes (
PBN 1/23/24, subscription required). However, 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 commercial payers revealed a variety of policies (see the telehealth coverage scorecard below).
The following plans accept telehealth codes 98000-98015:
The following payers only cover the audio/video codes.
The following plans do not accept the new codes and instruct providers to stick with the office/outpatient codes for telehealth services:
Update (3/25/25): Aetna will cover audio/video codes (98000-98007) and instructs providers to report audio-only visits with office/other outpatient E/M codes, according to a reader.
Help PBN build a complete telehealth coding scorecard for commercial plans. Share your commercial payers' telehealth coverage policies with links in the comments section or email julia.kyles[at]decisionhealth.com and we’ll update the scorecard.
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Telehealth private payer coverage scorecard (update 4/1/2025)
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Payer
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98000-98007
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98008-98015
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99202-99215
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Aetna
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✓
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Audio-only
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EmblemHealth
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✓
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Independence
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✓
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Coverage estricted to 6 specialties.
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BCBSMI
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Effective July 1
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Effective July 1
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BCBSNC
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✓
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BCBSND
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✓
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✓
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BCBSSC
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✓
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BCBSVT
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✓
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✓
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✓
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Premera Blue Cross
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✓
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✓
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PHP
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✓
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✓
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Regence
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✓
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UnitedHealth Care
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✓
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