Introduction
Billing for mental health telehealth services can be challenging due to various factors. Mental health providers must navigate different payer coverage and reimbursement policies, choose the correct CPT codes and modifiers, document telehealth services properly, comply with regulations related to telehealth, and educate patients about insurance coverage. Technical issues such as connectivity problems, audio or video quality issues, and software or hardware malfunctions can also disrupt the telehealth session and make it difficult to document and bill for the service. In this article, we will try to answer basic question how to bill mental health telehealth and all relevant questions about mental health telehealth billing.
How to Bill Mental Health Telehealth?
Billing for mental health telehealth services can be done using the same codes as for in-person mental health services. However, there are some specific requirements and guidelines that mental health providers need to follow when billing for telehealth services. Let’s see how to bill mental health telehealth?
1. Benefits Verification
To ensure reimbursement for providing mental health telehealth services, it is important to confirm that each patient’s insurance plan covers telehealth services and has approved the use of telehealth for the specific type of service being provided. While many insurance plans have expanded their coverage of telehealth services after COVID-19 pandemic, coverage and approval policies can vary widely between plans and may also depend on the patient’s specific diagnosis or treatment needs.
To verify coverage and approval, providers should contact each patient’s insurance plan and ask specifically about coverage for mental health telehealth services. Providers should also ask about any specific billing codes or modifiers required to bill for telehealth services and what documentation is needed to support the claim. It is also important to note that insurance plans may change their policies regarding telehealth coverage and approval at any time. Therefore, providers should stay up-to-date on any changes in policy and be prepared to adapt their billing practices accordingly to ensure that they continue to receive proper reimbursement for the telehealth services they provide. To ensure you get reimbursed for providing telehealth psychotherapy, always call each patient’s insurance plan and ask about approval for telehealth therapy.
2. Common Telehealth CPT Codes
The accurate CPT codes for mental health telehealth services can vary depending on the type of service being provided, the payer, and the location of the patient and provider. However, here are some commonly used CPT codes for mental health telehealth services:
Psychotherapy services:
- 90832 – Psychotherapy, 30 minutes with patient (individual or group)
- 90834 – Psychotherapy, 45 minutes with patient (individual or group)
- 90837 – Psychotherapy, 60 minutes with patient (individual or group)
Psychiatric diagnostic evaluations:
- 90791 – Psychiatric diagnostic evaluation
- 90792 – Psychiatric diagnostic evaluation with medical services
Medication management:
- 90863 – Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
It is important to note that CPT is a registered trademark of the American Medical Association (AMA). So we can’t complete list of applicable CPT codes along with their description. Codes listed above are shared for provider reference purpose only. Mental health providers should check with their payers to ensure that they are using the correct CPT codes and modifiers to bill for telehealth services. Additionally, some payers may have specific requirements for telehealth services, so providers should ensure that they are familiar with the payer’s policies and requirements before submitting claims.
3. Modifiers for Mental Health Telehealth
Telehealth modifiers indicate that a service was provided remotely, rather than in-person, and help payers to identify and process telehealth claims appropriately. Using the correct telehealth modifier is important for several reasons, including ensuring proper reimbursement, compliance with payer policies, data collection, and effective communication between providers. Mental health providers should ensure that they are familiar with the specific telehealth modifiers required by their payers and use them appropriately when billing for telehealth services. Key modifiers used for mental health telehealth are as follows:
- Modifier 95: Modifier 95 is used to indicate that a service was provided via telehealth. It can be used with many CPT codes to indicate that the service was provided remotely instead of in-person. Modifier 95 is recognized by Medicare and some other payers, but not all payers recognize this modifier.
- Modifier GT: Modifier GT is used to indicate that a service was provided via interactive audio and video telecommunication systems. This modifier was used prior to the creation of Modifier 95 and is no longer required by Medicare, but some other payers may still require it.
- Modifier GQ: Modifier GQ is used to indicate that a service was provided via asynchronous telecommunication system. This modifier is used for services that are not provided in real-time, such as the transmission of radiological images or ECG tracings.
- Modifier G0: Modifier G0 is used to indicate that a service was provided via telehealth and that the originating site was a patient’s home or other non-medical location. This modifier is used when the patient is not located in a healthcare facility or clinic when the telehealth service is provided.
Mental health providers should check with their payers to ensure that they are using the correct modifiers for telehealth services to avoid claim denials or delays. Additionally, providers should ensure that they are familiar with any additional requirements or documentation needed by the payer to bill for telehealth services.
4. Telehealth Place of Service Codes 02 and 10
Telehealth Place of Service (POS) codes are used to indicate the physical location where a healthcare service was provided. Two common POS codes for telehealth services are 02 and 10.
- POS code 02: This code refers to the use of telecommunication technology to provide health services and related services at a location other than the patient’s home. This means that the patient is not physically present in their own residence when receiving the services.
- POS code 10: POS 10, on the other hand, refers to the use of telecommunication technology to provide health services and related services in the patient’s home. This means that the patient is physically present in their own residence when receiving the services, as opposed to being in a hospital or other healthcare facility.
It’s important to note that the use of POS codes may vary depending on the payer and the specific service being provided.
We hope this article has answered the question how to bill mental health telehealth services. Detailed knowledge of benefits verification, CPT codes, modifiers, and place of service codes will ensure accurate claim payment of mental health telehealth claims. Medisys Data Solutions is a leading medical billing company providing complete billing and coding services. Our billing and coding experts are well aware of mental health telehealth billing guidelines to receive accurate insurance reimbursement for delivered services. To know more about our mental health telehealth billing services, contact us at info@medisysdata.com / 888-720-8884
