For years, we've been arguing about the wrong things. Should a video visit pay the same as an in-person one? Do we need a new code for a quick e-consult? These debates feel important, but they're just noise. The real problem is much bigger - and almost nobody in benefits is talking about it.
Here's the hard truth: telehealth billing today is a retrofit. We took a payment system built for face-to-face, fee-for-service medicine and simply dropped a video call into it. The result? We're paying for a new, efficient way to deliver care using an old, wasteful payment model. And that mismatch is quietly killing the value virtual care was supposed to deliver.
The 90-Day Float Nobody Mentions
The real issue isn't which code to use. It's when and how the money moves. In a typical setup, a telehealth visit generates a claim that gets paid 30 to 90 days later - exactly like an in-person appointment. From a benefits administration standpoint, this is a copy-paste of a broken process.
Here's the part that rarely gets discussed: that billing cycle actually rewards inefficiency. A health system makes money based on Relative Value Units (RVUs). Whether care is delivered in a $500-per-minute operating room or a $2-per-minute Zoom call, the payment is roughly the same if the CPT code matches. So the system pockets the difference - a hidden subsidy for expensive, legacy infrastructure.
This is why many large health systems haven't fully embraced low-cost telehealth. They're not slow. They're rational. They don't want to cannibalize their profitable in-person visits. The current billing structure isn't designed to reward efficiency. It's designed to reward the appearance of a visit.
Stop Billing for the Visit. Start Billing for the Outcome.
The fix is staring us in the face, but it requires a completely different mindset. Stop thinking of a telehealth visit as a billable event. Think of it as a behavioral trigger - a free, zero-co-pay entry point into a smarter system. The real revenue doesn't come from the claim. It comes from everything that happens next.
Let me give you a concrete example from a model that's already doing this: the WellthCare ecosystem.
How a Health-to-Wealth System "Bills" for Telehealth
- Make the visit free. The $0 co-pay virtual consult is the Trojan horse. The low marginal cost of a video platform is trivial compared to a physical visit. So absorb it. The real value is downstream.
- The "bill" becomes the data. That 15-minute conversation generates a personalized plan of care. It triggers a preventive action - a lab test, a scan, a medication refill. The system tracks that action and rewards the employee with real, spendable dollars or a retirement deposit. The "payment" is not a claim; it's a behavioral incentive that proves the system is working.
- Capture waste, not revenue. Imagine a telehealth visit for a sinus infection. Old model: $100 claim, plus a PBM spread on the prescription - total $120, with 20-25% waste. Aligned model: the visit is free, the prescription goes through an integrated pharmacy at cost+10%, and the margin that used to be waste now funds the employee's store dollars and pension. The telehealth visit becomes a profit center - not by charging more, but by eliminating the friction around it.
Three Questions Every Benefits Leader Should Ask Right Now
If you want to fix your telehealth billing, stop obsessing over modifiers. Ask these three things instead:
- Is your telehealth contract a waste capture or a cost center? If you're paying $100 for a $30 virtual visit, you're subsidizing fee-for-service. Renegotiate to a flat per-member-per-month fee for unlimited virtual care. Then focus on how that care redirects spending.
- Are you using telehealth to feed a readiness index? The real ROI isn't lower claim costs per visit. It's the data. In a modern system, each telehealth interaction feeds a proprietary Readiness Index that proves to the employer: "Your population is X% ready for self-funding. Here's the projected $3M savings." The visit is an investment in generating that proof.
- Have you switched your billing unit from a code to a wallet? The future of billing for effective care isn't a CPT code. It's the employee's wallet - store dollars and pension contributions that reward healthy behavior. And the employer's wallet - savings from vastly reduced total cost of care.
The Bottom Line
The tired debate about telehealth billing codes is a distraction. It keeps us optimizing a broken system instead of building a better one.
The real move is to go upstream. The "bill" for a telehealth visit in an aligned ecosystem isn't a claim. It's the value of preventing a future heart attack. It's the data that powers a smarter health plan. It's the economic surplus that becomes a retirement contribution.
Stop trying to bill for the video call. Start building the system that bills for the outcome.