Audio-Only Telehealth Billing Rules

Where audio-only stands in 2026

The old telephone E/M codes 99441–99443 are gone, deleted from CPT effective 2025. That leaves three possible paths for a phone visit, and which one applies depends entirely on the payer:

• Standard E/M plus modifier 93. The Medicare pattern: bill 99202–99215 with modifier 93 when the patient is at home, the practice is capable of video, and the patient cannot or will not use it.
• The audio-only telemedicine codes 98008–98015. CPT’s dedicated audio-only E/M series. Adopted by some plans, ignored by others. These codes require more than 10 minutes of medical discussion.
• 98016, the brief virtual check-in, for short patient-initiated calls that do not rise to an E/M visit, where recognized.

Post-PHE rules have settled but keep moving at the margins, especially on audio-only. This page is a quarterly-review candidate.

Modifier 93 vs modifier 95

The split is clean: 95 means synchronous audio and video, 93 means synchronous audio without video. A visit takes exactly one of them. If video connects for part of the visit and carries the substantive portion, most payers accept 95; if the visit was functionally a phone call, bill 93. See Modifier 95 for the video-side rules. The POS logic is unchanged by modality: 10 at home, 02 elsewhere, per POS 02 vs 10.

Consent and time documentation

Audio-only claims get reviewed more often than video claims, so the note has to carry more weight:

• Consent to a telehealth visit, documented, and current per the payer’s cadence
• Why audio-only. One line is enough: video unavailable, patient declined video, connection failed
• Time in medical discussion. Audio-only leveling leans on time, and the 98-series has an explicit more-than-10-minutes floor. State minutes, not “lengthy discussion”
• Location of the patient, since the home requirement is load-bearing for Medicare-pattern coverage

Payer divergence

This is the least uniform corner of telehealth billing. Across a typical OB payer mix you will find plans that pay 99213+93 at parity, plans that only recognize 98008–98015, plans that cover audio-only for a limited code list, and plans that cover video only. None of that is visible on the claim form, only in each payer’s policy. Capture it on your payer grid rather than rediscovering it through denials.

When audio-only makes the visit non-billable

• The payer covers synchronous video only, and the visit happened by phone
• The medical discussion ran under the payer’s time floor and no check-in code applies
• The call was routine prenatal follow-up for a global patient, which would not bill separately in any modality since it counts toward the global package visit schedule

Non-billable does not mean undocumented. Chart the encounter fully: it supports continuity, the global visit count, and medical necessity for whatever comes next. And when a video attempt fails mid-visit, document the failure; that line is what justifies modifier 93 instead of a lost charge.

FAQ

What is modifier 93 in medical billing? It is the CPT modifier identifying a service delivered by synchronous, real-time audio-only communication, appended to the standard code where the payer covers audio-only delivery.

Can I bill a regular office visit code for a phone call? For payers following the Medicare approach, yes: 99202–99215 with modifier 93, provided the patient is at home, video was offered and not usable, and time and consent are documented. Other payers want the 98008–98015 series or do not cover audio-only E/M.

What happened to 99441, 99442, and 99443? CPT deleted the telephone E/M codes effective 2025. Claims still going out with those codes will reject; the replacement path depends on the payer as described above.

Does an audio-only prenatal check-in count toward the global package? Yes, if it substitutes for a routine prenatal visit it counts toward the visit schedule, and like any routine prenatal visit it does not bill separately.