Telehealth Visits and Your wRVU Pay: What Counts (2026)
Published July 24, 2026 · Tatanka Labs
Two questions, one answer each
The wRVU you earn from a telehealth encounter comes down to two questions that are completely independent of each other. First: which CPT code does the visit generate? That is determined by CMS billing rules and the delivery mode (audio-video versus audio-only), and it sets the raw wRVU value. Second: does your employment contract count those wRVUs toward your productivity bonus? That is purely a contract term, set by your employer, with no required relationship to the CMS value.
The first question has a clear technical answer. The second requires you to read your contract. Both matter — and confusing one for the other is the source of most telehealth-pay misunderstandings.
Video telehealth: same codes, same wRVUs as in-person
For a real-time audio-video encounter, billing rules require the same outpatient evaluation and management codes used for in-person care: 99202–99205 for new patients and 99212–99215 for established patients. The claim typically carries modifier 95 (synchronous telehealth) or a telehealth place-of-service code, but the CPT code itself does not change.
Because the code is unchanged, the work RVU is unchanged. A moderate-complexity established-patient visit coded as a 99214 generates 1.92 wRVUs whether conducted in the exam room or over a video link. A high-complexity new patient 99205 produces 3.50 wRVUs in either setting. No discount is applied to the CMS work value for video-delivered care.
| CPT code | Visit type | 2026 wRVU (in-person = video) |
|---|---|---|
| 99202 | New patient — straightforward | 0.93 |
| 99203 | New patient — low complexity | 1.60 |
| 99204 | New patient — moderate complexity | 2.60 |
| 99205 | New patient — high complexity | 3.50 |
| 99212 | Established — straightforward | 0.70 |
| 99213 | Established — low complexity | 1.30 |
| 99214 | Established — moderate complexity | 1.92 |
| 99215 | Established — high complexity | 2.80 |
These values are from the 2026 CMS Physician Fee Schedule and apply identically to in-person and video telehealth encounters that use these codes.
Audio-only visits: new codes, slightly lower wRVUs
A phone-only visit — no video, audio only — follows a different billing path. CMS permanently retired the old telephone codes (99441, 99442, and 99443) effective January 1, 2025. Those codes are no longer valid and will be denied if submitted. They were replaced by two new families of audio-only evaluation and management codes:
- 98008–98011: audio-only E&M visits for new patients
- 98012–98015: audio-only E&M visits for established patients
These codes use the same medical decision-making or total-time documentation framework as their in-person counterparts. Their work RVU values are close to — but modestly lower than — the equivalent in-person codes, reflecting the absence of a physical examination.
Established patients: audio-only vs. in-person
| Audio-only code | 2026 wRVU | In-person equivalent | In-person wRVU | Difference |
|---|---|---|---|---|
| 98012 | 0.65 | 99212 | 0.70 | −7% |
| 98013 | 1.20 | 99213 | 1.30 | −8% |
| 98014 | 1.75 | 99214 | 1.92 | −9% |
| 98015 | 2.60 | 99215 | 2.80 | −7% |
New patients: audio-only vs. in-person
| Audio-only code | 2026 wRVU | In-person equivalent | In-person wRVU | Difference |
|---|---|---|---|---|
| 98008 | 0.90 | 99202 | 0.93 | −3% |
| 98009 | 1.55 | 99203 | 1.60 | −3% |
| 98010 | 2.42 | 99204 | 2.60 | −7% |
| 98011 | 3.20 | 99205 | 3.50 | −9% |
One payer-specific nuance: Medicare's current rules for audio-only telehealth coverage generally require the standard office-visit codes (99212–99215) with modifier 93 attached to indicate telephone delivery, rather than the 98008–98015 family. When that is the case, the wRVU for a Medicare audio-only visit is the same as the in-person equivalent. Commercial payers that have adopted the new code families bill 98008–98015 directly. The code that actually gets submitted determines the wRVU that enters your productivity count.
The 2026 efficiency adjustment left telehealth alone
Beginning January 1, 2026, CMS reduced the work RVU values for roughly 7,700 non-time-based codes by 2.5% as part of a broad efficiency recalibration. Procedural, surgical, imaging, and diagnostic codes were the primary targets.
Evaluation and management codes — the office-visit family used for in-person and video telehealth — were explicitly excluded from the adjustment. So were the new audio-only codes. The rationale is that E&M codes are time-based services, and the efficiency methodology CMS applied did not extend to that category. If the bulk of your clinical volume is outpatient E&M, your per-visit wRVU generation was unaffected by the 2026 change regardless of delivery mode.
Whether your employer credits them is a different question entirely
CMS assigning a wRVU value to a telehealth code means the work was counted in the measurement system. It does not mean your employer is required to pay you for that wRVU or apply it to your bonus threshold. That decision lives entirely in your employment contract, and the policies vary.
Three patterns are common in the market:
- Full credit at the same rate: telehealth wRVUs count exactly like in-person wRVUs toward your threshold and bonus. This is now the most common arrangement at practices where virtual care is a routine care channel, not an exception.
- Excluded from productivity: some contracts — particularly those drafted before 2020 and not meaningfully updated since — list "telehealth," "telephone," or "virtual visits" as excluded services that generate no bonus credit, even when the CPT code produces real wRVUs. Physicians at these practices are essentially working part of their panel for base salary only.
- Tracked separately at a lower rate: a smaller group of employers credit telehealth wRVUs at a discounted per-wRVU dollar amount, or count them toward a separate sub-threshold before the standard production bonus rate applies.
If your practice runs 20–30% of encounters over telehealth, the gap between full credit and exclusion can add up to several thousand dollars per year at typical per-wRVU rates. It is worth knowing which policy you are operating under before those encounters accumulate.
What to confirm before you sign
Four specific things to nail down:
- Does "eligible services" in your contract include telehealth visits? Look for a definition of covered services or an exclusion list. A contract that does not mention telehealth at all is ambiguous, not permissive — ambiguity typically resolves in the employer's favor at reconciliation time.
- Does the definition cover audio-only visits as well as audio-video? Contracts sometimes specify "synchronous telehealth" or "audio-video encounters" without addressing phone-only visits. Because audio-only now uses different CPT codes (98008–98015 for many payers), it may fall outside the definition even when audio-video is included.
- Which CMS schedule year does your contract reference for wRVU values? If the contract pins a year before 2025, the 98008–98015 audio-only code families may not appear in the fee schedule your employer uses to assign wRVUs. Confirm that audio-only codes are present and assigned the expected values.
- If a different per-wRVU rate applies to telehealth, what is your expected telehealth volume? Multiply your anticipated telehealth wRVUs by the rate difference to see the actual annual dollar impact before deciding whether to push back on the term.
Frequently asked questions
Is a video telehealth 99214 worth the same wRVUs as an in-person 99214?
Yes. For a real-time audio-video visit, billing rules require the same CPT code as in-person care — 99214 for a moderate-complexity established-patient visit. Because the code is identical, the work RVU is identical: 1.92 wRVUs either way. The only billing difference is a modifier or place-of-service indicator noting the telehealth delivery mode.
What replaced the old telephone codes 99441, 99442, and 99443?
CMS permanently deleted 99441, 99442, and 99443 as of January 1, 2025. They were replaced by two new audio-only E&M code families: 98008–98011 for new patients and 98012–98015 for established patients. These codes follow the same medical decision-making or total-time documentation standard as in-person E&M codes and are recognized by many commercial payers. Medicare generally continues to require standard E&M codes (99212–99215) with modifier 93 for audio-only visits rather than the new families.
Do audio-only visits generate fewer wRVUs than in-person visits?
Usually, but modestly. When billed under the 98008–98015 code families (used by many commercial payers), audio-only visits carry wRVU values roughly 3–9% lower than equivalent in-person codes, reflecting the absence of a physical exam. For established patients, the gap runs about 7–9% across complexity levels. For new patients, the lower levels are nearly even (around 3% less) and the gap widens at higher complexity (up to 9% at the highest level). When Medicare requires standard E&M codes with modifier 93, the wRVU is the same as in-person.
Does my employer have to give me wRVU credit for telehealth visits?
No. Employers can contractually define which services count toward your productivity total. Even when telehealth encounters generate real wRVUs in the CMS fee schedule, your contract may exclude them, credit them at a lower rate, or track them separately. This is a negotiable contract term, not a CMS requirement. If your practice has meaningful telehealth volume, clarify the contract language before signing rather than discovering the exclusion at year-end reconciliation.
Were telehealth codes affected by the 2026 CMS efficiency adjustment?
No. CMS explicitly exempted time-based evaluation and management services — including the standard office-visit codes used for video telehealth and the new audio-only code families — from the 2.5% efficiency adjustment that took effect January 1, 2026. That reduction applied to roughly 7,700 non-time-based procedural, surgical, imaging, and diagnostic codes. E&M office visits and telehealth codes were not affected.
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This article is for general educational purposes only and is not financial, legal, tax, or career advice. wRVU values reflect the CMS Physician Fee Schedule and may change; always confirm figures against your own contract and current CMS data. Billing and coding rules change frequently; verify payer-specific requirements with your billing department or a qualified coding specialist.