Insurance Reimbursement for TeleMental Health

Telemedicine, Including TeleMental Health, Codes for ‘Modifier’,
CPT Codes, and Place of Service

By Ofer Zur, Ph.D.

This page is part of an online CE course
TeleMental Health: The New Standard – Ethical, Legal, Clinical, Technological, and Practice Considerations

Note: It is very important to check with the insurance plan to determine whether telemental health services are covered and, if they are, which codes or modifer should be used to cover different types of telemental health services. It is very important to check directly with the insurance company because the coverage for telemental health services continues to evolve, change and modified.

For 2018 update on billing codes including Telehealth CPT Codes:

For updated billing and CPT info

Eligibility for Reimbursement for TeleMental Health

Some states have laws that require, in some form or another, for private insurers and/or that state’s Medicaid program to cover telehealth services. In states without these requirements, insurers may cover it anyways. The resources page for this course includes links to information regarding which states have these requirements and which ones do not.

A growing number of private insurers require professionals to perform additional paperwork before they can bill for telemental health sessions. This additional paperwork usually requires the professional to give attestations regarding their telemental health practice procedures. At the time of writing, no two processes were alike in the authors’ experiences. You will simply need to contact all the insurers with whom you are paneled, find out what processes they require, and seek any necessary assistance from there.

Note that it would be wise to inquire with private insurers regarding telemental health coverage rather than simply performing remote sessions and hoping the insurance company will decide to cover them. That has sometimes worked in the past, but is becoming increasingly unlikely to work. What’s worse is that it could work at first, but then you could find yourself having to return funds once the insurer realizes they paid for sessions they did not want to pay for.

As for Medicare: it is one of the largest payers for telehealth services, especially those delivered to Medically Underserved Areas (MUAs.)

TeleMental Health Session Coding

The methods of coding for telemental health sessions are not set in stone and can change from situation to situation, but there are a number of consistent elements to it. A properly coded claim for remote sessions needs to consider the code for the place of service as well as the CPT code and other modifiers.

Rather than try to describe the vicissitudes in this article, we refer you to this excellent video lecture from Simple Practice’s “Ask a Biller” video blog series that explores the specific codes to use and circumstances under which to use them: Telehealth: Billing Insurance and Getting Paid.

EAP Services Through TeleMental Health

A large number of EAP programs actively recruit telemental health practitioners to supply EAP services remotely. To find these programs, you can contact major employers in your area or inquire with your local chapter of the Employee Assistance Professionals Association (EAPA.)

Additionally, new services that work to link telemental health providers with health care systems — or directly with clients — are popping up every day. We encourage you to closely consider all your ethical and legal duties before signing on with these services, as they generally are not beholden to the same ethical and legal standards that you are. That said, there are many such services that can be invaluable in helping clinicians to grow a telemental health practice.

For updates and more information

The American Medical Association revises coding manual for 2017

Additional resources regarding Insurance, Billing, Reimbursement & CPT Codes in E-Therapy & TeleMental Health

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