Stellerdobes - I have posted elsewhere on this site information / definitions about Telehealth in the C19 era. Medicare relaxed some requirements in order to facilitate limiting patient exposure, particularly the older patients.
In this relaxing of requirements, "Telehealth" is distinct from "Telemedicine"
For Telehealth, Medicare allows the service to be billed as though it were an office visit. Medicare directs that all who can should "visit" with the provider through a video exchange. But Medicare recognizes what you have said: some of the older patients only have phones. Medicare allows that exchange using only phones to also be billed as Telehealth.
Given this, telephone "visits" with older patients should not pay less than the video chats do. I'm guessing the provider is confusing the phone "visit" with a different category (can't remember the name at the moment) which is to be used for short exchanges where the patient calls to get a prescription refill or some other brief exchange with the doctor or his staff. That type of phone call does get paid far less than the phone call that is a Telehealth visit. But a phone "visit" with the provider should pay the same as a video "visit" with the provider - for a given level of service.
The one thing to keep in mind is that a Telehealth visit cannot contain any activities that must be done with the patient in the doctor's presence. So, for example, you would not have an ear lavage on a Telehealth visit. Based on that principle, Medicare cautions that an excess of 99214 Telehealth visits is likely to trigger an audit - since codes above 99213 generally include activities that require the patient to be in the provider's presence.
