Telehealth has revolutionized mental health care by making it more accessible to patients regardless of their geographic location. As we step into 2025, mental health providers must stay informed about evolving telehealth billing regulations to ensure compliance and optimize reimbursement. This article provides a comprehensive overview of telehealth mental health billing updates for 2025, addressing key questions, coding changes, and regulatory updates that impact billing practices.
Will Medicare Stop Paying for Telehealth in 2025?
One of the pressing questions for healthcare providers is whether Medicare will continue reimbursing telehealth services in 2025. The good news is that Medicare has extended many telehealth flexibilities initiated during the COVID-19 Public Health Emergency (PHE) through March 2025. Congress’s decision reflects the growing recognition of telehealth’s role in improving healthcare access.
However, these extensions come with stipulations. Providers must remain vigilant about evolving policies, especially concerning geographic and site-of-service requirements that may change post-March 2025. Mental health providers should monitor updates from the Centers for Medicare & Medicaid Services (CMS) to ensure uninterrupted reimbursement.
What Is the CPT Code for Telehealth in 2025?
CPT codes are essential for billing telehealth services accurately. Commonly used CPT codes for mental health telehealth include:
- 90791 and 90792: Psychiatric diagnostic evaluation.
- 90832, 90834, 90837: Psychotherapy sessions (30, 45, and 60 minutes respectively).
- 90846 and 90847: Family psychotherapy.
For 2025, these codes continue to apply to telehealth services when performed via live video or audio-only platforms, provided they meet Medicare’s coverage requirements. Modifier 95 should be appended to these codes to indicate telehealth delivery. Additionally, providers should stay updated on any new CPT codes or revisions introduced in the 2025 Medicare Physician Fee Schedule.
2025 Telehealth Coding Changes
With the release of the Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule, several telehealth coding changes have been implemented:
- Expanded Audio-Only Coverage: Medicare has extended coverage for audio-only mental health services in certain situations. This ensures accessibility for patients without video-capable devices.
- Permanent Additions to the Telehealth Services List: Specific services, including some mental health evaluations, are now permanently covered under telehealth.
- Temporary Codes: Certain telehealth services added during the PHE remain temporarily covered until further evaluation.
Except for these coding changes, the 2025 Medicare Physician Fee Schedule (PFS) includes other critical updates impacting telehealth billing for mental health providers. Key highlights include:
- Reimbursement Rates: Adjustments to reimbursement rates for telehealth services ensure parity with in-person visits in many cases.
- Provider Eligibility: Continued allowance for non-physician mental health professionals, such as clinical social workers and psychologists, to deliver telehealth services.
- Telehealth Flexibilities: Extension of several waivers, including those related to rural and geographic restrictions.
Mental health providers should review the PFS final rule and the complete list of covered telehealth services to incorporate these billing changes.
Telehealth Visits and Modifiers for 2025
Accurate coding is crucial for telehealth reimbursement. Key modifiers include:
- Modifier 95: Indicates a service provided via telehealth.
- Modifier GT: Used for interactive audio and video telecommunications.
- Modifier FQ: Denotes audio-only telehealth services.
Using the correct modifiers ensures claims are processed efficiently and reduces the risk of denials.
2025 Medicare Reimbursement
Medicare’s reimbursement policies for telehealth in 2025 emphasize parity between telehealth and in-person visits for many services. However, reimbursement rates may vary based on:
- Provider type (e.g., physicians vs. non-physician mental health professionals).
- Service delivery mode (e.g., video vs. audio-only).
- Compliance with coding and documentation requirements.
Providers should regularly review fee schedules to ensure accurate billing and optimal reimbursement.
Conclusion
The landscape of telehealth mental health billing in 2025 presents both opportunities and challenges. By staying informed about Medicare’s policies, coding updates, and reimbursement guidelines, mental health providers can optimize their billing practices and continue delivering high-quality care to their patients. Partnering with expert billing services can further simplify compliance and ensure financial stability in a rapidly evolving healthcare environment.
About Medisys Data Solutions (MDS)
At Medisys, we specialize in simplifying telehealth billing for mental health providers. With our in-depth understanding of Medicare policies, CPT coding, and compliance standards, we ensure accurate claims submissions and maximize your reimbursements. Our team stays updated on the latest regulatory changes, so you don’t have to. Partner with us to streamline your billing operations and focus more on patient care. Contact us today to learn how we can assist you with telehealth mental health billing in 2025 and beyond.
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