Is Telehealth Covered by Insurance?

For physical therapists, integrating telehealth services has opened new doors for patient engagement, convenience, and continuity of care. But one question continues to linger among PT professionals and practice owners: Is telehealth covered by insurance?

The answer is: yes, but it depends on several factors - namely the type of insurance (Medicare, Medicaid, private), state regulations, and service eligibility. This article breaks down everything PT professionals need to know about telehealth insurance coverage, with specific focus on reimbursement, legal considerations, and how to make the process smoother using practice management tools.

What Does “Telehealth Covered by Insurance” Really Mean?

When we ask is telehealth covered by insurance, we're essentially trying to determine whether health insurance plans - government-funded or private - will pay for remote care services delivered via video, phone, or other digital methods. For physical therapists, this can include virtual evaluations, consultations, follow-up appointments, and even guided exercise programs.

Coverage is determined by:

• Type of insurance (Medicare, Medicaid, private)
  
  
• State-specific regulations
  
  
• Provider and service eligibility
  
  
• Reimbursement parity laws
  
  

Let’s explore each of these in depth.

1. Medicare and Telehealth in Physical Therapy

Medicare Part B does cover telehealth, but its scope has evolved—particularly in response to the COVID-19 pandemic. Until September 30, 2025, Medicare beneficiaries can receive telehealth services from any location, including their home, regardless of rural status.

For physical therapy, the following are important:

• PTs were temporarily allowed to bill Medicare for telehealth services under a waiver.
  
  
• CMS (Centers for Medicare & Medicaid Services) has extended telehealth reimbursement for therapy services at least through 2025.
  
  
• Reimbursement is currently subject to standard Part B cost-sharing (typically 20% after deductible).
  
  

However, after October 1, 2025, many telehealth services - including some PT offerings - may revert to stricter location and facility-based rules unless new legislation is passed.

2. Medicaid: Varies by State

Medicaid coverage for telehealth is highly state-dependent. Some states have comprehensive telehealth programs that include physical therapy, while others offer limited or no coverage.

Key factors include:

• Modality restrictions (live video, audio-only, store-and-forward)
  
  
• Service location (e.g., patient’s home vs. clinic)
  
  
• Eligible provider types (some states include PTs, others don’t)
  
  
• Reimbursement parity
  
  

To determine if your PT telehealth service is reimbursable under Medicaid, you’ll need to:

• Check your state Medicaid program’s telehealth policy
  
  
• Ensure your services are rendered by an eligible provider type
  
  
• Confirm approved telehealth CPT codes
  
  

3. Private Insurance Coverage for PT Telehealth

Private insurers generally do cover telehealth, including for physical therapy, but details vary by provider and plan. Many insurers embraced telehealth more broadly after 2020 and have continued to include it as a covered benefit.

Factors influencing private insurance telehealth coverage:

• State parity laws: 22+ states currently require payment parity (equal reimbursement for telehealth and in-person services).
  
  
• Plan-specific guidelines: Some plans require prior authorization or restrict services to in-network providers.
  
  
• Coding accuracy: Correct use of CPT codes and modifiers is essential to receive reimbursement.

For PT practices, this means that verifying patient benefits is more important than ever. Many insurers cover initial evaluations and follow-ups via telehealth, but you must confirm it case by case.

4. How to Make Telehealth Insurance Coverage Work for PT

So, is telehealth covered by insurance for physical therapy? In most cases, yes - but getting reimbursed requires knowledge and preparation.

Here are practical steps PT practice owners should follow:

a) Verify Insurance Benefits

Before every telehealth session, verify the patient’s plan allows telehealth, includes PT, and confirms coverage for the specific service and code.

b) Use the Right CPT Codes and Modifiers

Common CPT codes used in telehealth PT sessions include:

• 97110: Therapeutic exercises
  
  
• 97112: Neuromuscular re-education
  
  
• 97116: Gait training
  
  
• 97530: Therapeutic activities
  Use the modifier 95 for synchronous telehealth services where applicable.
  
  

c) Document Thoroughly

Include time spent, modality (e.g., video), service details, patient consent, and goals. Accurate documentation improves billing success and compliance.

d) Stay Updated on Laws

Reimbursement laws and payer policies shift often. Subscribe to updates from your state PT board or national organizations.

e) Streamline with Software

Use integrated PT software to verify benefits, document telehealth sessions, apply the correct codes, and submit clean claims to insurers.

How PtEverywhere Helps You Succeed with Telehealth and Insurance

PtEverywhere, a physical therapy software platform, is uniquely designed to support you through the complexities of telehealth insurance billing and compliance:

With PtEverywhere, your practice can focus less on red tape and more on patient outcomes - while confidently navigating insurance reimbursement.

Telehealth Coverage Is Here to Stay

While the landscape of telehealth insurance coverage is still evolving, the momentum is clear—telehealth is a permanent fixture in healthcare. For physical therapists and practice owners, understanding the nuances of telehealth covered by insurance can mean the difference between denied claims and successful reimbursements.

By staying informed about Medicare timelines, Medicaid variability, and private insurance policies, PT providers can confidently integrate virtual care into their offerings. Combined with practice management software like PtEverywhere, telehealth becomes not only feasible but highly effective and profitable.