Therapy & behavioral health · 25 October 2026

Common CPT and Modifier Mistakes on Telehealth Therapy Claims

The CPT code, modifier and place-of-service errors that most often get telehealth therapy claims denied or underpaid, and how to prevent them

Telehealth therapy claims fail for a surprisingly small set of reasons. The session was real, the note is fine, and the client is covered, but one field on the claim doesn't match what the payer expects. Because the same mistake is usually repeated on every claim for that payer, a single set-up error can quietly block weeks of payments.

This article is a checklist of the most common CPT, modifier and place-of-service mistakes on telehealth therapy claims. If you want the background on how telehealth billing works, start with our guide to billing telehealth therapy sessions.

This is general information. Payer rules differ and change, so confirm current policy with each payer.

Mistake 1: Using the wrong place of service code

The two telehealth place of service (POS) codes are:

POS 10: telehealth provided in the patient's home
POS 02: telehealth provided somewhere other than the patient's home

The mistake is setting one POS for every payer. Some payers want POS 10 or 02. Others ask you to report the POS you would have used in person (often 11, office) and show telehealth with a modifier instead. Medicare's preferences have also shifted over time. If a payer starts denying or paying telehealth sessions at an unexpected rate, the POS is one of the first things to check.

Fix: keep a payer grid listing each payer's required POS and modifier for video and audio-only sessions, and set your EHR's defaults per payer where possible.

Mistake 2: Missing, wrong or doubled-up telehealth modifiers

Common telehealth modifiers in behavioral health:

95: synchronous audio-video telehealth
93: synchronous audio-only telehealth (where the payer allows it)
FQ: Medicare's audio-only indicator in certain situations
GT: an older audio-video modifier still required by some Medicaid programs and legacy policies

Typical errors include leaving the modifier off when the payer requires it, using 95 on an audio-only session, and stacking 95 and GT together. Some payers ignore modifiers entirely, which makes it easy to assume they don't matter until a payer that does care starts denying.

Fix: record the modality (video or audio-only) in every note and make sure the modifier on the claim matches it.

Mistake 3: Choosing the psychotherapy code that doesn't match documented time

Individual psychotherapy codes are time-based:

90832: 16–37 minutes
90834: 38–52 minutes
90837: 53 minutes or more

The CPT time rules apply the same way on telehealth as in person. Billing 90837 for a session documented at 50 minutes, or not documenting time at all, is one of the most frequent audit findings in therapy billing. Video sessions that start late because of connection problems are a common cause.

Fix: document start and stop times, or total face-to-face time, for every session, and bill the code the documented time supports. Some payers also review high volumes of 90837, so make sure the note explains the need for longer sessions.

Mistake 4: Misusing add-on codes

Add-on codes can't be billed alone and only go with certain primary codes.

90785 (interactive complexity) can be reported with diagnostic evaluations and psychotherapy codes when the documentation shows a specific complicating factor. It isn't reported with crisis psychotherapy (90839/90840), and it shouldn't be added just because the session was by video.
90833, 90836 and 90838 are psychotherapy add-ons used only with an E/M visit on the same day, typically by psychiatric prescribers. They are not used by therapists billing psychotherapy alone.
90840 (each additional 30 minutes of crisis psychotherapy) can only follow 90839.

Fix: set up your EHR so add-on codes can only be selected with valid primary codes, and review any claim that uses one.

Mistake 5: Assuming every service is covered by telehealth

Most payers cover individual psychotherapy by video. Coverage for other services varies more, including group psychotherapy (90853), family psychotherapy (90846/90847), diagnostic evaluations, and anything delivered audio-only. Some payers limit audio-only to established clients or require that video was offered first.

Fix: check telehealth coverage per service, not just per payer, and note any limits in the payer grid.

Mistake 6: Confusing new telemedicine E/M codes with psychotherapy

CPT introduced new telemedicine evaluation and management codes (98000–98015) in 2025. They are E/M codes, not psychotherapy codes, and payer adoption has been uneven, with Medicare not adopting most of them. Therapists billing psychotherapy should keep using the standard psychotherapy codes with the payer's required POS and modifier unless a payer specifically instructs otherwise.

Mistake 7: The wrong provider on the claim

Telehealth often goes hand in hand with growth: new clinicians, supervised associates, clinicians in other states. Claims are denied when:

The rendering clinician isn't credentialed with that payer yet
A pre-licensed clinician is billed under a supervisor in a way the payer doesn't allow
The clinician isn't licensed in the state where the client was located during the session

Fix: before scheduling a client, confirm the clinician is credentialed with the client's plan and licensed in the client's state. Our article on credentialing vs billing explains how these fit together.

Mistake 8: Diagnosis codes that don't support the service

Unspecified diagnosis codes, or diagnoses that don't match the treatment plan, can trigger denials or medical-necessity reviews. Use the most specific diagnosis the clinical documentation supports and update it when the clinical picture changes.

Mistake 9: Not fixing the root cause after the first denial

A single telehealth denial is rarely a one-off. If a payer denies one claim for a POS or modifier problem, every claim built the same way will usually deny too. Correcting just that one claim leaves the rest to fail.

Fix: when a telehealth denial comes back, check how many other claims for that payer share the same set-up, correct the template, and resubmit corrected claims or appeals before the payer's deadline. Our page on behavioral health denial management describes this workflow.

A pre-submission checklist for telehealth therapy claims

Is the POS what this payer requires for this modality?
Does the modifier match video vs audio-only, with no conflicting extras?
Does the documented time support the CPT code?
Are add-on codes paired only with valid primary codes?
Is the service covered by telehealth under this plan?
Is the rendering clinician credentialed with the plan and licensed where the client was located?
Is the diagnosis specific and consistent with the treatment plan?

Next step

If telehealth claims are being denied or paid inconsistently, MedBill Solutions can review them and take over billing inside your existing EHR. See our insurance billing for therapists service, or if denied telehealth claims have piled up, our old claims service works them for 3% of what we recover, with no fee if nothing is recovered. We reply within one business day.

Telehealth claims being denied?

We review denied telehealth claims and take over billing inside your EHR. Old denied claims: 3% of what we recover, no fee if nothing is recovered. We reply within one business day.

Insurance billing for therapists → Old claims service