Video has become the default for telehealth, and for good reason. Being able to see a patient provides valuable visual context that supports clinical assessment and strengthens the therapeutic relationship. But video is not always the right choice, and in some situations audio-only is not just acceptable, it is the better option. Understanding when to use each modality makes you a more flexible and effective provider.
When Video Is the Right Choice
Video is generally the preferred modality when visual assessment is part of the clinical encounter. This includes dermatology and wound checks where visual inspection is the primary tool, pediatric visits where observing a child’s demeanor and interaction with caregivers matters, physical therapy follow-ups that require seeing the patient move or demonstrate exercises, mental health sessions where reading facial expressions and body language is part of the therapeutic process, and initial visits with new patients where building rapport benefits from face-to-face connection.
Video also tends to produce higher patient satisfaction scores and is more consistently reimbursable under most payer policies, which is worth factoring in when both options are clinically appropriate.
When Audio-Only Is the Better Option
Audio-only is the right choice in several situations. Technology access and comfort are the most common drivers. Older patients, those in rural areas with slow connections, and patients using basic mobile phones may struggle with video in ways that disrupt the session more than they help it. If a patient repeatedly has video problems that consume the first ten minutes of your appointment, audio-only may produce a better clinical encounter.
Privacy is another consideration. Patients calling from shared living situations, workplaces, or other environments where they cannot comfortably be on video may be more willing to engage honestly in an audio-only format. A patient who is visibly uncomfortable on camera is not in the right headspace for a productive clinical conversation.
Some visit types simply do not require video. Medication refill checks, quick follow-ups on stable chronic conditions, and administrative calls are examples where the absence of video does not diminish clinical quality.
Compliance and Billing Considerations
The regulatory landscape around audio-only telehealth has evolved considerably. Medicare and many Medicaid programs allow audio-only visits under specific conditions, typically when video is not available to the patient and the provider documents why. Several states have added audio-only parity laws that require insurers to reimburse phone visits at the same rate as video. When you conduct an audio-only visit, note the reason in your visit record, whether it was patient preference, technology limitations, or a specific clinical consideration.
CPT modifier 93 designates synchronous audio-only telehealth services, distinct from modifier 95 used for audio-visual visits. Using the correct modifier protects your billing and ensures accurate records.
Offering the Choice to Your Patients
A practical approach is to default to video while making audio-only available as an explicit option. When you send appointment reminders or pre-visit instructions, let patients know they can request a phone visit if they prefer or if they expect technology difficulties. This small accommodation removes friction, reduces no-shows caused by tech anxiety, and demonstrates flexibility that patients appreciate.
SecureVideo supports both modalities, giving you and your patients options without requiring a separate workflow. Meeting patients where they are, whether on camera or on the phone, is part of delivering care that actually reaches them. Start your free trial today at www.securevideo.com.