The post-pandemic telehealth landscape has created a bifurcated billing environment that demands real-time operational precision. CMS permanently extended behavioral health telehealth for in-home visits after 2024 — while other COVID-era flexibilities were discontinued or not renewed. Every state Medicaid program maintains its own telehealth coverage policy. Commercial payers have adopted varying degrees of coverage parity, with some requiring in-person equivalent documentation and others applying entirely different billing logic for audio-only visits. For hospitals managing telestroke consultations, teleICU programs, virtual urgent care, remote patient monitoring, and chronic care management simultaneously, telehealth billing touches multiple service lines — and each carries distinct CPT, modifier, documentation, and payer-specific requirements that must be managed with current, applied knowledge.