Telehealth Billing

It’s a scenario that makes every private practice owner’s stomach drop. You pull your weekly remittance advice, expecting a healthy reimbursement for a complex patient session where you billed multiple units or multiple distinct codes. Instead, the payment that hits your account is a fraction of what you calculated. Your first instinct? Call it an underpayment, blame a payer glitch, and gear up for a timely filing appeal. But before you spend hours on hold or drafting appeal

If you have been wondering whether Medicare still reimburses virtual therapy visits, the direct answer is yes. Physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs), and audiologists remain fully eligible to bill Medicare for Telehealth services through December 31, 2027. While political debates and temporary funding fights caused confusion early in the year, Congress officially resolved the status of therapy Telehealth. Here is what ha

It is one of the most frustrating notifications a private practice owner can receive. You submit a clean batch of claims, wait weeks for reimbursement, and instead open a Remittance Advice marked with a rejection code: Denied for Incorrect NPI. This specific rejection is incredibly common, yet completely avoidable. The most frustrating part is that an incorrect NPI claim denial often has absolutely nothing to do with you doing anything wrong clinically. Your NPI is real, your

By Danielle Wagar, CPES | Upstate Healthcare Admin Blue Cross Blue Shield is not a single insurance company. This is the thing most providers do not fully understand when they get credentialed with their local BCBS plan - and it is why BCBS claims can behave so differently depending on the patient in front of you. BCBS is a federation of 33 independent, locally operated member plans. When your patient has a BCBS plan from another state, the BlueCard Program governs how their

By Danielle Wagar, CPES | Upstate Healthcare Admin If you bill for telehealth sessions, you have almost certainly encountered modifier 95 and modifier GT. You may have used them interchangeably. You may have used the wrong one without knowing it and had no idea why claims denied. This guide clarifies exactly when each modifier applies and why using the wrong one will get your claims denied. What Telehealth Modifiers Do Telehealth modifiers are codes appended to a CPT procedur

Aetna's reimbursement changes for therapists credentialed through Alma took effect on July 15, 2026, as scheduled. If you are a solo therapist, psychologist, LCSW, LPC, or LMFT using Alma to bill Aetna, the rate changes are no longer something to prepare for they're now live on your claims. Here's exactly what changed, what happened between the announcement and the effective date, and what your options look like now. On May 20, 2026, Alma notified its providers that Aetna wo