Telehealth billing continues to vary by payer, especially for audio-only services, modifier use, and place of service rules. To reduce claim denials and make documentation easier for providers, Claimpower has updated templates to match each payer’s current telehealth policy.
Aetna
Aetna’s telemedicine policy applies to both Commercial and Medicare Advantage plans. Under the policy, audio-only services billed with modifier 93 are not paid, while audio-video services are addressed under the plan’s telemedicine rules. Aetna also states that telemedicine claims may be billed without a POS 02 or POS 10 restriction, so a POS requirement is not the focus for this payer.
Cigna Commercial
Cigna’s commercial virtual care policy allows both audio-only and audio-video telehealth services when the billed code is eligible under the plan’s virtual care list. The policy indicates that claims should be billed with POS 02, and reimbursement depends on the service appearing on Cigna’s eligible code list.
Weblink: https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/R31_Virtual_Care.pdf
Horizon BCBSNJ
Horizon BCBSNJ covers both audio-only and audio-video telehealth services for plans processed as primary, including Commercial and Medicare Advantage. The policy allows modifier 93 for audio-only services and modifier 95 for audio-video services, and it accepts POS 02 and POS 10. Horizon also publishes an eligible code list for telemedicine and telehealth reimbursement.
Weblink: https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/telemedicine-and-telehealth-services
UHC Commercial and Exchange
UnitedHealthcare commercial and individual exchange plans cover both audio-only and audio-video telehealth services, but modifier 93 is allowed only for certain CPT codes listed in the policy. POS 02 and POS 10 are both acceptable, and the payer’s eligible code list appears on the referenced policy page.
UHC Community Plans
UHC Community Plan policies vary by state, so billing rules depend on the specific Medicaid program. For Texas, the policy allows modifier 93 only for certain CPT codes and includes a state-specific telehealth eligible code list; for some states such as NJ and TX, the policy notes no POS restriction for selected situations.
Weblink: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Telehealth-and-Telemedicine-Policy.pdf
BCBS of Texas
BCBS of Texas covers both audio-only and audio-video telehealth services for Commercial and Medicare Advantage plans processed as primary. The policy allows modifier 93 and modifier 95, accepts POS 02 and POS 10, and includes a telehealth eligible code list for covered services.
Weblink: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Telehealth-Virtual-Health-Policy-Professional-and-Facility-R7133.pdf
Claimpower Template Changes
To align medical records with these payer rules, Claimpower updated the templates in two ways. First, the Chief Complaint section now includes additional telehealth buttons with dummy codes for Consent – Audio Only and Consent – Audio and Video. Second, once the provider selects the correct telehealth chief complaint and E/M visit, the system automatically applies the appropriate modifier during claim submission. This reduces provider’s workload and helps ensure the claim matches the selected visit type.
Why This Matters
These template changes support cleaner documentation, fewer billing errors, and better consistency with payer-specific telehealth requirements. They also make it easier to identify whether the encounter was audio-only or audio-video, which is especially important for payers that treat those services differently.
Billing Telehealth visits
1st Step – On the charting screen, click on Chief Complaint as shown in below image:
2nd Step – select the required template (Consent Audio or Consent Video)
Once we hit DONE, there will be a procedure on the charting screen with the template. This will help Claimpower bill the appropriate telehealth codes with the correct modifier, indicating whether the visit was conducted via audio or video.
