Telehealth reimbursement
Telehealth reimbursement is an important factor to consider when expanding your offerings to virtual sessions.
Summary
- Telehealth reimbursement rules differ across Medicaid, Medicare, and private insurers, with oversight split between federal and state regulations.
- Coverage varies by plan. Always verify CPT codes, credentialing, and prior authorization requirements before providing services. Using an EHR like TheraPlatform can help therapists bill with ease.
- Many states now require private insurers to reimburse telehealth at the same rate or cover the same services as in-person visits, but specifics vary. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge.
- Telehealth policies shift frequently; use trusted resources like CCHP, CMS, and payer portals to keep current and avoid denied claims.
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After you’ve decided on your technology, chosen your HIPAA-compliant video conferencing platform, and delineated the process for adding telehealth services such as teletherapy to your practice, there next question you need to ask:
“How will I get paid?”
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The answer is both simple and complex. The fact is, you can have cutting-edge technology and be a rockstar therapist but if you’re not getting paid, you’re not getting anywhere but frustrated.
You may have some clients able and willing to self-pay, but most will rely on their health insurance to pay for therapy services. Setting up your telehealth practice to optimize insurance reimbursement takes planning and research.
To help you on your way, in this article, we’ll outline tips and considerations for telehealth reimbursement by Medicaid, Medicare and private insurance.
Telehealth reimbursement plans are not created equal
How nice would it be if there was one sweeping telehealth reimbursement policy to rule them all? One that spanned all public and private insurance.
While it sounds lovely, at this point, it is only a fairytale. Instead, in our current system, all telehealth reimbursement plans are not created equally and understanding how various payer sources reimburse and allow for telehealth therapy services is key to maximizing payments.
You may be tempted to accept only cash pay for telehealth, avoiding the confusion of learning about different plans, but most people will want to use their insurance plans.
They often pay a great deal of money for coverage and value the opportunity to meet their deductible or save money for other necessary services. So let’s dive into some of the specifics.
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Federal vs state oversight for telehealth reimbursement
While telehealth policies and legislation have undergone regular reevaluation and renewal since 2020, much of the original allowances are still in effect (though additional congressional action is required by September 30, 2025).
Today, the complex web of federal and state oversight means that coverage for telehealth reimbursement varies by state.
Federal policies set basic standards that apply nationwide (like HIPAA) and affect federally-funded programs like Medicare, while states have control over more direct aspects of medical practice like licensing and reimbursement, private insurance and the provision of Medicaid-covered services.
In summary, there is no universal telehealth reimbursement policy, and it is important to understand both federal and state regulations as well as the rules for private insurance plans.
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Center for Connected Health Policy
If you are feeling overwhelmed by the variability in coverage for telehealth services, you are not alone. Thankfully, organizations like the Center for Connected Health Policy do a lot of that work for you.
They regularly update federal policies and link you to resources outlining the current state-specific policies for jurisdictions throughout the country.
They recommend seeking out the answers to four specific questions when researching the telehealth reimbursement policies for a given payer:
- What specific services are eligible for reimbursement?
- Who can be reimbursed? PT, OT, speech?
- Where can the patient be when receiving services?
- How is the service being delivered as in, which modality?
Additionally, we recommend the following questions to help you cover your bases:
- Is the provider credentialed for telehealth?
- Are there limitations on which CPT codes will be reimbursed?
- Is prior authorization needed?
- What documentation is required?
By asking these questions, you will better understand the types of services you can bill under telehealth policies for a specific payer source. Next, we’ll look at a few of them in more detail.
Medicaid and telehealth reimbursement
Let’s start with Medicaid. Each state defines its own coverage and services for telehealth reimbursement.
In general, telehealth services can be provided through four different modalities:
- Live video
- Audio only
- Remote patient monitoring and
- Store-and-forward
As of the latest count, 31 state Medicaid programs currently reimburse for all four modalities, while all 50 states plus Washington D.C., and Puerto Rico reimburse for at least some form of video telehealth services, according to CCHPCA.
To understand the specific Medicaid coverage and reimbursement in your state, we recommend checking out their website.
Print out a copy of the policy criteria and specific information you need and be sure to understand the credentialing requirements required by your state program.
Private pay for telehealth reimbursement
As of August 2025, many (but not all) states have private payer parity laws in place to address reimbursement for telehealth services.
These laws typically address two types of pay parity, according to the National Conference of State Legislatures:
- Payment parity for telehealth (41 states + DC): Requires that telehealth reimbursement be at the same payment rate or amount as if the care were delivered in person
- Telehealth coverage/service parity (22 states): Requires that the same services that can be delivered in person are also covered for telehealth
That being said, the exact amount and coverage of therapy services by a private insurance for telehealth therapy differs by plan just as it does for in-person services.
Visit the plan’s website or call one of their representatives to understand their unique telehealth policies and inquire about specifics like credentialing and panel policies.
Medicare for telehealth reimbursement
Finally, let’s explore Medicare. Medicare’s telehealth policies are defined federally.
According to the government’s telehealth information website, as of today:
- Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through September 30, 2025.
- There are no geographic restrictions for originating sites for Medicare non-behavioral/mental telehealth services through September 30, 2025.
- Telehealth services can be provided by all eligible Medicare providers through September 30, 2025
Do your research to learn which CPT codes are covered under which circumstances and make an effort to stay up to date on CMS policy changes and temporary waivers.
Preparing to treat clients
In this ever-changing landscape of telehealth legislation, always verify coverage and benefits before beginning a treatment plan. You don’t want to find out that the type of therapy you are providing is excluded from coverage or that you lack the appropriate credentialing after the fact.
After researching the telehealth reimbursement policies for federal, state and private plans in your area, you may have a couple more hurdles to cross.
First, did you know that some plans require separate credentialing for telehealth services, especially if you will be seeing patients who are located in another state? We recommend keeping records of the credentialing status for each payer to reference in the future.
Second, verify if a prior authorization is needed before starting or continuing the patient’s care. Retroactive authorizations are rarely successful, so check telehealth benefits carefully and have a system for keeping track of which clients need prior auth and the status of each auth request.
Staying current with telehealth reimbursement
As we write this article, changes and updates are going on to telehealth policies in the background. In fact, hundreds of telehealth-related bills are introduced yearly and policy shifts vary by state and insurance type.
So, how do you stay informed?
We recommend bookmarking regularly visited key resources such as these:
- Center for Connected Health Policy (CHHP)
- Centers for Medicare & Medicaid (CMS)
- Your state Medicaid website
- Payer provider portals
Also, consider joining professional groups or listservs for real-time updates and subscribing to telehealth policy newsletters or billing updates.
Telehealth reimbursement starts with understanding payer policies. Don’t leave money on the table. Verify every time, stay informed, and use the right tools. Telehealth is here to stay and you want to build your practice on a sustainable, billable foundation.
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How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports mental and behavioral health, SLPs, OTs, and PTs in group and solo practices
More resources
- Therapy resources and worksheets
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- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
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- Insurance billing 101
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References
- https://www.cchpca.org
- https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2024/
- https://www.ncsl.org/health/the-telehealth-explainer-series/telehealth-private-insurance-laws
- https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates
FAQs for telehealth reimbursement
Does every insurance plan reimburse telehealth sessions the same way?
No. Telehealth reimbursement varies widely across Medicaid, Medicare, and private insurers. Some states have parity laws requiring equal coverage or payment, but the specifics depend on the payer and plan.
What should therapists check before billing for telehealth services?
Therapists should verify whether the service is covered, confirm CPT code eligibility, check credentialing requirements, and determine if prior authorization is needed to avoid denials.
How can I stay up to date on changing telehealth reimbursement policies?
Bookmark trusted resources like the Center for Connected Health Policy (CCHP), CMS updates, your state Medicaid site, and payer portals. Joining professional groups or listservs also helps with real-time updates.
