Orthopedic practices now handle post-surgery follow-ups and physical therapy checks through video visits. The problem isn’t providing care remotely it’s getting insurance companies to pay for it.
One missing modifier means your claim gets denied. Wrong place of service code? Denied. Missing patient location in your notes? Denied.
We process orthopedic telehealth claims at MedLife every day. When practices outsource their medical billing services, the same billing mistakes show up repeatedly if proper workflows aren’t in place. Here’s how to bill telehealth visits correctly and get paid on the first submission.
Medicare Telehealth Coverage: What’s Covered Through 2027
Congress extended Medicare telehealth coverage through December 31, 2027. Your orthopedic practice can bill for video visits with patients at home. Phone consultations count too. Geographic restrictions don’t apply patients in rural Pennsylvania and downtown Chicago get the same coverage.
This extension isn’t permanent law. When December 2027 approaches, Congress needs to act again. Don’t build your entire practice model around something that might change.
CPT Codes for Orthopedic Telehealth: Medicare vs Private Insurance
Medicare rejected the new telehealth codes (98000-98015) created in 2025. Use your regular office visit codes instead:
- 99202-99215 for new and established patients
- Add Place of Service code 02
- Add modifier 93 for phone-only visits (when video wasn’t available)
Private insurance is inconsistent. Blue Cross might accept the new telehealth codes. United Healthcare might want traditional codes with modifier 95. Aetna has its own rules. Call each payer’s provider line and confirm before you submit claims.
Your billing staff needs separate workflows for Medicare and commercial payers. Accurate medical coding services become even more important with telehealth because wrong code selection whether it’s the CPT code, modifier, or place of service triggers automatic denials.
Practices already managing prior authorization challenges in orthopedic practices know how insurance companies make simple tasks complicated.
Telehealth Reimbursement Rates for Orthopedic Practices
Medicare pays identical rates for telehealth and in-person visits through 2027. A 99213 follow-up visit pays the same whether your patient drives to your office or connects from their living room.
Private insurance reimbursement varies by contract. Some payers match Medicare. Others pay 80% of the in-person rate. Some have separate fee schedules for virtual visits.
The biggest billing error? Failing to verify coverage before the appointment. The claim gets denied three weeks later and now you’re chasing the patient for payment they didn’t expect.
Pre-Visit Verification Checklist
Before scheduling any telehealth appointment, your front desk should confirm:
☐ Patient’s insurance plan covers telehealth for orthopedic follow-ups
☐ Specific visit type is eligible (post-op vs new injury vs medication review)
☐ Prior authorization required or not
☐ Patient’s copay amount for telehealth (may differ from office visit)
☐ Patient can access video on phone/computer or needs phone-only option
☐ Patient’s current location (some states have different rules)
Run this verification during scheduling, not after you’ve already seen the patient.
Best Orthopedic Services for Telehealth (And What Needs Office Visits)
A 2024 study in Cureus surveyed 522 orthopedic patients about their telehealth experience. Results showed 77.9% overall satisfaction, jumping to 92.3% among post-surgical patients without complications. The catch? 65% still needed face-to-face assessment afterward.
Telehealth works well for:
Post-op check-ins where you assess healing, review range of motion and confirm patients follow their recovery plan. Physical therapy reviews where patients demonstrate exercises at home you see exactly how they perform movements in their actual environment. Medication adjustments for chronic conditions. Reviewing X-rays or MRI results with patients. Pre-surgical consultations with established patients.
Skip telehealth for:
New patient evaluations with acute injuries. Any physical exam requiring hands-on assessment. Injections. Manual treatments. Manipulation procedures.
Practices that understand how independent orthopedic practices can stay competitive use telehealth strategically, not universally. Wrong application creates liability risk and poor patient outcomes.
Need Help with Orthopedic Billing?
Book a free consultation to simplify your billing, speed up reimbursements, and cut down denials.
TALK TO AN EXPERTDocumentation Requirements for Telehealth Claims
Your telehealth notes need the same clinical detail as office visits, plus telehealth-specific elements that Medicare auditors look for first.
Document patient consent a simple note works: “Patient consented to telehealth visit.” Record patient location with city and state. Medicare wants this information. Missing it triggers claim reviews.
Specify the technology: video or phone. If you used phone-only, explain why video wasn’t available (patient couldn’t access technology, connection issues, patient preference). Document your clinical findings the same way you would for an office visit. If billing by time, write exact minutes: “24 minutes total including pre-visit chart review, 16-minute video encounter, post-visit documentation.”
Copy-pasting template language into every note creates audit red flags. Auditors recognize identical documentation patterns across multiple patients.
5 Telehealth Billing Errors That Trigger Claim Denials
Wrong CPT codes: Don’t use telephone codes 99441-99443 for clinical video visits. Those codes apply only to brief phone calls that don’t result in a visit within 24 hours. Use 99212-99215 with appropriate modifiers instead.
Missing documentation: Claims need patient location, consent and technology type documented. Leave these out and auditors reject your claim during review.
Billing global period services: Post-op visits within the 90-day global period are included in your surgery payment. You can conduct them via telehealth, but you can’t bill separately. Adding a telehealth code doesn’t change the global period rules.
Incorrect modifiers: Medicare wants modifier 93 for audio-only visits. Private payers might want modifier 95. Using the wrong one gets your claim automatically denied.
Skipping coverage verification: Some insurance plans exclude telehealth for specific services. Verify before the visit, not after the denial arrives.
Telehealth Claim Submission Process
Follow this workflow for every telehealth claim to catch errors before submission:
Medicare vs Private Insurance: Quick Reference Chart
| Element | Medicare Requirements | Private Insurance Requirements |
| CPT Codes | 99202-99215 (standard E/M codes) | Check payer – may use 98000-98015 or standard E/M codes |
| Place of Service | Code 02 (telehealth) | Code 02 or 10 (verify with payer) |
| Video Visit Modifier | No additional modifier needed | Often requires Modifier 95 |
| Phone-Only Modifier | Modifier 93 (when video unavailable) | Varies by payer |
| Documentation Needed | Patient consent, location (city/state), technology type, clinical notes, time (if applicable) | Same as Medicare plus any payer-specific requirements |
| Prior Authorization | Rarely required for follow-ups | Check each payer’s policy |
Before submitting any claim, verify:
- Patient consent documented
- Patient location noted (city and state)
- Technology type specified (video or phone)
- If phone: reason why video wasn’t available
- Clinical notes support the code level billed
- Time documented if billing by time
This is part of effective orthopedic revenue cycle management catching mistakes before claims leave your office prevents denials and payment delays.
Why Orthopedic Practices Outsource Telehealth Billing
Each insurance company maintains different requirements. United Healthcare wants one set of codes. Cigna wants another. Aetna has its own rules. Tracking these variations while seeing patients creates mistakes.
Billing companies that handle orthopedic specialty billing understand telehealth claims for musculoskeletal practices. They know which codes Anthem accepts versus what Humana requires. They track when Medicaid changes its telehealth policies. They handle denied claims without pulling your staff away from scheduling and patient calls.
At MedLife, we manage billing for orthopedic practices including telehealth claims. Your providers see patients. We handle the paperwork and make sure you get paid correctly for every visit.
Seeing telehealth claim denials pile up? We’ll review your billing process, identify where claims fail and fix the problems. Contact MedLife to discuss your specific billing challenges.