Teletherapy Billing: A Comprehensive Guide for Providers

Teletherapy has revolutionized mental and behavioral health care by offering accessible and convenient therapy options. However, billing for teletherapy services can be complex, requiring a deep understanding of coding, documentation, and payer-specific policies. This comprehensive guide dives into the essential aspects of teletherapy billing, focusing on critical areas like CPT codes, modifiers, documentation requirements, and insurance reimbursement policies.

Teletherapy Billing: A Comprehensive Guide for Providers

1. CPT Codes for Teletherapy Billing

In teletherapy billing, selecting the correct CPT codes is critical to ensure proper reimbursement. While the same CPT codes used for in-person services often apply to teletherapy, it’s essential to pair them with appropriate modifiers and place of service (POS) codes.

Commonly Used CPT Codes for Teletherapy (Mental Health Services)

• 90837: Psychotherapy, 60 minutes
• 90834: Psychotherapy, 45 minutes
• 90832: Psychotherapy, 30 minutes
• 90791: Psychiatric diagnostic evaluation (without medical services)

Please note that these codes must reflect the duration of the therapy session accurately and include documentation of telehealth delivery.

Some of the documentation tips for CPT codes include:

• Include the start and end time of the session.
• Document that the service was provided via telehealth, including the platform used (e.g., Zoom, Doxy.me).
• Ensure the patient’s verbal or written consent for telehealth is recorded at least once per episode of care.

2. Modifiers and Place of Service (POS) Codes

Teletherapy claims require the correct use of modifiers and POS codes to signal that the service was delivered remotely. Misusing these can lead to claim denials or reduced payments.

Teletherapy-Specific Modifiers

• Modifier 95: Indicates synchronous telehealth service rendered via real-time interactive audio and video.
• Modifier GT: Previously used for telehealth, now payer-specific (check with commercial insurers).
• Modifier -25: Used when a separate and distinct evaluation (e.g., therapy + diagnostic assessment) is performed on the same day.

Place of Service (POS) Codes 

• POS 02: Indicates telehealth services provided anywhere other than the patient’s home.
• POS 10: Used when telehealth services are provided to a patient in their home.

Always confirm the correct POS code with each payer as requirements can vary.

3. Insurance Reimbursement Policies for Teletherapy

Insurance coverage for teletherapy has evolved significantly, especially post-pandemic. Understanding payer-specific policies is essential for timely reimbursement.

Medicare Reimbursement

Medicare covers teletherapy under specific guidelines:

• Eligible Providers: Includes licensed clinical social workers (LCSWs), clinical psychologists, and other licensed professionals.
• Reimbursement Rates: Typically the same as in-person visits when appropriate modifiers are applied.

Medicaid Policies

Medicaid coverage for teletherapy varies by state, but most states now offer robust telehealth benefits for mental health services.

• Check state-specific Medicaid guidelines to ensure compliance.
• Verify if your state requires audio-visual platforms or allows audio-only sessions.

Commercial Payer Policies

Private payers may have different policies regarding teletherapy reimbursement:

• Always verify coverage and billing requirements before the session.
• Some payers may not reimburse for telehealth services unless certain conditions are met (e.g., the patient’s location or the use of specific technology).

4. Detailed Documentation Requirements

Accurate and thorough documentation is vital for ensuring compliance and preventing claim denials. Key elements include:

Essential Documentation Elements

• Session Notes: Clearly document the content of the session, therapeutic interventions used, and patient response.
• Telehealth Platform: Note the telehealth platform used (e.g., HIPAA-compliant Zoom) and any technical difficulties.
• Patient Consent: Record patient consent for telehealth services, including a statement that the patient agreed to receive services via teletherapy.

Example Documentation Template

“Session conducted via [Platform Name] on [Date]. The session lasted [Duration], starting at [Start Time] and ending at [End Time]. The patient consented to telehealth. Discussed [summary of session content, therapeutic interventions]. No technical difficulties encountered.”

Always use templates to streamline documentation while ensuring all required elements are captured.

To conclude,

Teletherapy billing is challenging, requiring precise coding, accurate documentation, and a thorough understanding of payer policies. By mastering these complexities, mental and behavioral health providers can ensure timely and accurate reimbursement while focusing on delivering quality care.

At Medisys, we specialize in mental health billing, including teletherapy services. Our team stays updated on the latest regulations and payer policies to ensure seamless billing. Contact us today to learn how we can support your practice and maximize your teletherapy revenue.

Disclaimer: CPT® is a registered trademark of the American Medical Association (AMA). For more detailed information on CPT codes, please refer to the AMA’s official site.