How do we bill telehealth services for Medicaid OB/GYN patients?

Medicaid telehealth coverage varies by state. Most state Medicaid programs now cover synchronous video visits for OB/GYN services including prenatal visits, postpartum check-ins, and gynecology consultations. Some states also cover audio-only services. We monitor all state Medicaid telehealth policies and apply the correct billing approach for each patient's payer.

2026 Telehealth Rules — Permanent Coverage Confirmed

OB/GYN Telehealth Billing — Every Virtual Visit Properly Reimbursed

Q: What is the difference between GT modifier and 95 modifier?

Modifier GT (via interactive audio and video telecommunications systems) is used for Medicare claims submitted to Part B for telehealth services. Modifier 95 (synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) is used for commercial payer claims. For most 2026 commercial payer billing, modifier 95 is preferred. Always verify individual payer policy.

Q: Are OB/GYN telehealth services permanently covered by Medicare in 2026?

Yes. The Consolidated Appropriations Act extended and made permanent many telehealth flexibilities introduced during the COVID-19 public health emergency, including coverage for OB/GYN E/M visits, mental health services, and certain preventive services. Audio-only coverage under specific codes was also extended through 2026 under ongoing legislation.

Q: What audio-only billing codes can OB/GYN practices use?

For telephone-only (audio-only) services, OB/GYN practices can bill CPT 99441 (5–10 min), 99442 (11–20 min), and 99443 (21–30 min) for telephone E/M services. HCPCS code G2012 covers brief virtual check-in services. G2252 covers brief communication technology-based service. G0071 is used for audio-only communication technology-based services under certain payer contracts.

Modifier errors cost OB/GYN practices thousands per month in denied telehealth claims. We apply the correct CPT codes, modifiers, and place-of-service codes for every payer — so your virtual visits get paid the first time.

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98.2%

Telehealth First-Pass Rate

Missed Modifier Revenue

8 Payers

Policy Libraries Maintained

2026

Policy Current

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2026 Updates

What Changed for Telehealth Billing in 2026

Permanent flexibilities, new POS requirements, and audio-only rule clarifications — all built into our billing workflows.

✓

Permanent Telehealth Coverage Extended

Congress made permanent the COVID-era telehealth flexibilities for Medicare, including OB/GYN E/M visits, mental health integration, and expanded home-as-originating-site rules. No cliff dates for core OB telehealth services.

📞

Audio-Only Rules Clarified

CMS finalized audio-only coverage for patients who cannot access video technology, particularly for OB patients in rural areas or with limited smartphone access. Documentation must note inability to use video.

🏠

POS 10 Becomes Dominant

POS 10 (Telehealth — Patient at Home) is now the primary place-of-service code for home-based telehealth, replacing the COVID-era workaround of using POS 11 with modifier 95. POS 10 carries different reimbursement rates than POS 02.

🤰

OB Global Period Telehealth

Antepartum and postpartum telehealth visits within the global maternity package must be tracked carefully. Services inside the global period billed separately can trigger audits. We track global dates and flag all telehealth claims within maternity packages.

⚖️

Interstate Licensure Compact

The Interstate Medical Licensure Compact (IMLC) now covers 40+ states, enabling OB/GYN physicians to bill across state lines for telehealth. We verify provider licensure against patient location before every claim submission.

Video Visit Codes

Synchronous Telehealth CPT Codes

E/M codes with telehealth modifiers — the backbone of OB/GYN virtual care billing.

CPT Code	Description	Modifier	Typical Duration	OB/GYN Application
`99213`	Office/Outpatient E/M — Low Complexity	`95 or GT`	20–29 min	Follow-up telehealth visit, minor concerns
`99214`	Office/Outpatient E/M — Moderate Complexity	`95 or GT`	30–39 min	Prenatal follow-up, contraception consult, GYN management
`99215`	Office/Outpatient E/M — High Complexity	`95 or GT`	40–54 min	Complex GYN conditions, high-risk OB, multiple management decisions
`99421`	Online Digital E/M — 5–10 min cumulative	`None`	5–10 min	Asynchronous patient portal messages billed in 7-day period
`99422`	Online Digital E/M — 11–20 min cumulative	`None`	11–20 min	Moderate portal/app-based consultation
`99423`	Online Digital E/M — 21+ min cumulative	`None`	21+ min	Complex asynchronous digital management

Audio-Only

Telephone & Audio-Only Billing Codes

Many OB/GYN patients — especially rural, elderly, or postpartum mothers — cannot access video telehealth. Proper audio-only billing prevents lost revenue and ensures access.

Documentation requirement: For audio-only visits, the clinical note must specifically state why video was not feasible (e.g., patient lacks smartphone, poor connectivity, patient preference for accessibility reasons). Without this documentation, payers may downgrade or deny audio-only claims.

99441CPT

Telephone E/M — Established Patient

Duration: 5–10 minutes

Coverage: Medicare, Medicaid, most commercial

99442CPT

Telephone E/M — Established Patient

Duration: 11–20 minutes

Coverage: Medicare, Medicaid, most commercial

99443CPT

Telephone E/M — Established Patient

Duration: 21–30 minutes

Coverage: Medicare, Medicaid, most commercial

G2012HCPCS

Brief Virtual Check-In

Duration: 5–10 minutes

Coverage: Medicare Part B

G2252HCPCS

Brief Communication Technology-Based Service

Duration: 11–20 minutes

Coverage: Medicare Part B

G0071HCPCS

Audio-Only Communication Tech Service (FQHC/RHC)

Duration: Variable

Coverage: Medicare FQHC/RHC

Modifier Guide

Telehealth Modifiers — When to Use Which

Wrong modifier = automatic denial. Our billing team knows exactly which modifier to apply for each payer type.

95Synchronous Telemedicine

Use when: Commercial payer video visits

Required by most BCBS, Aetna, UHC, Cigna plans for video-based E/M

GTInteractive A/V Telecom

Use when: Medicare Part B video visits

Used on Medicare claims for real-time video telehealth services

93Synchronous Telemedicine — Audio-Only

Use when: Audio-only commercial claims

New in 2023 — replaces G2010 approach for many commercial payers

GQAsynchronous Telehealth

Use when: Store-and-forward services

Federal telemedicine programs; rarely used in standard OB/GYN

Place of Service (POS) Codes for Telehealth

POS 02Telehealth — Provider Location

When: Patient is NOT at home

Patient at office, clinic, or facility; provider at different location

POS 10Telehealth — Patient at Home2026 Standard

When: Patient IS at home

Post-PHE standard — patient connected from their own home or residence

POS 11Office

When: In-person follow-up same day

Cannot use same day as telehealth for same service/same payer

Payer Policies

Telehealth Coverage by Major Payer

We maintain up-to-date telehealth policy libraries for every major payer your OB/GYN practice accepts.

Payer	Video Visits	Audio-Only	POS Required	Modifier	Key Notes
Medicare	✓	✓ (G2012, G2252)	`POS 02 or 10`	`GT`	Permanent coverage 2026; originating site waived for home visits
Medicaid	✓ (varies by state)	✓ (select states)	`State-specific`	`GT or 95`	All 50 states cover OB video visits; audio-only varies
BCBS	✓	Plan-specific	`POS 10 (home)`	`95`	Most BCBS plans cover prenatal + GYN telehealth; verify plan
Aetna	✓	Limited	`POS 02 or 10`	`95`	Covers 99213–99215 with modifier 95; audio-only case-by-case
UnitedHealthcare	✓	✓ (99441–99443)	`POS 02 or 10`	`95`	Full telehealth parity in most states for OB/GYN
Cigna	✓	Plan-dependent	`POS 02 or 10`	`95`	Requires virtual care designation; verify network participation
Humana	✓	✓	`POS 02 or 10`	`GT or 95`	Strong telehealth coverage; Humana Telehealth Policy updated Q1 2026
Tricare	✓	Limited	`POS 02`	`GT`	Direct care and purchased care programs differ; verify beneficiary plan

Error Prevention

Top Telehealth Billing Errors We Eliminate

High

Wrong Modifier for Payer

Using GT on commercial claims (should be 95) or 95 on Medicare (should be GT) causes immediate CO-4 denials. We maintain a payer-modifier matrix that is updated with every policy change.

High

Incorrect POS Code

Using POS 11 (office) instead of POS 10 (patient home) or POS 02 (non-home) causes claim rejections or reimbursement at wrong rate. Every telehealth claim must reflect where the patient is located.

High

Billing Telehealth Within Global Period

Antepartum telehealth visits billed separately when included in global maternity package triggers overpayment letters. We track every global package enrollment date against telehealth visit dates.

Medium

Missing Audio-Only Documentation

Audio-only (telephone) claims denied when the note doesn't document why video was not used. We flag audio-only claims for documentation review before submission.

Critical

Cross-State Licensure Not Verified

Billing for telehealth when provider is not licensed in patient's state violates law and causes clawbacks. We verify licensure for every provider-patient state combination.

Medium

Duplicate Billing — Telehealth + In-Person Same Day

Billing a telehealth E/M and in-person E/M on the same day for the same condition triggers medical necessity review. Legitimate same-day services require modifier 25 on one service.

98.2%

First-Pass Rate

$4.2M

Revenue Recovered

200+

OB/GYN Practices Served

Major Payer Policy Libraries

FAQ

Telehealth Billing Questions

Which CPT codes apply to OB/GYN telehealth visits in 2026?

OB/GYN telehealth visits use standard E/M codes 99213, 99214, and 99215 with modifier 95 (commercial) or GT (Medicare). Video visits require real-time audio-video capability. Audio-only visits use 99441–99443 or HCPCS G2012/G2252. Place of service codes 02 or 10 are required on all telehealth claims.

What is the difference between GT modifier and 95 modifier?

Modifier GT is used for Medicare Part B telehealth claims and indicates interactive audio-video telecommunications. Modifier 95 is used for commercial payer claims and indicates synchronous telemedicine. Using the wrong modifier causes immediate denials — we apply the correct modifier based on payer type, state, and service type for every claim.

Are OB/GYN telehealth services permanently covered by Medicare in 2026?

Yes. Core OB/GYN telehealth services are permanently covered under Medicare including standard E/M visits, antepartum check-ins (when not in global package), and postpartum follow-up. The Consolidated Appropriations Act locked in most PHE flexibilities through 2026 and beyond for standard care delivery.

What audio-only billing codes can OB/GYN practices use?

For telephone-only visits: CPT 99441 (5–10 min), 99442 (11–20 min), 99443 (21–30 min). HCPCS G2012 covers brief virtual check-ins (5–10 min) for Medicare. G2252 covers 11–20 minute brief technology-based services. Audio-only documentation must specifically note why video was not used.

How do we handle telehealth billing within the OB global maternity package?

Antepartum visits within the global package (59400, 59510, 59610, 59618) are included in the global fee and should not be billed separately regardless of whether they are telehealth or in-person. If a patient changes insurance mid-pregnancy, antepartum visits — including telehealth — may be billed with 59425/59426. We track every global period date to prevent overbilling and audit exposure.

“We were losing around $3,200 per month on denied telehealth claims because our staff was using modifier 95 on Medicare claims instead of GT. OBGYNBillingPro caught this in the first audit, corrected the modifier mapping, and we haven’t had a telehealth denial since.”

Dr. Sara Okonkwo, MD

Women's Health Partners — Chicago, IL

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