Mastering Telehealth Billing: What Every Mental Health Practice Needs to Know

Creare Solutions
Apr 29
3 min read

The landscape of mental health care has undergone a significant transformation with the advent of telehealth. The convenience and accessibility of virtual consultations have made mental health services more reachable than ever before. However, with this shift comes the intricate task of telehealth billing—a process that requires precision, up-to-date knowledge, and adaptability.

Mastering telehealth billing is crucial for mental health practices to ensure timely reimbursements, maintain compliance, and continue providing quality care without financial hindrances. This guide aims to equip mental health professionals with the necessary insights to navigate the complexities of telehealth billing effectively.

Understanding Telehealth Billing Basics

Definition and Scope of Telehealth Services

Telehealth encompasses the delivery of health care services through digital platforms, allowing for remote consultations, diagnoses, and treatments. In mental health, this includes services like psychotherapy, counseling, and psychiatric evaluations conducted via video conferencing or phone calls.

Key Components: CPT Codes, Modifiers, and POS Codes

Accurate billing starts with understanding the essential components:

CPT Codes: These codes describe the services provided. For mental health telehealth services, common CPT codes include:
- 90791: Psychiatric diagnostic evaluation
- 90832: Psychotherapy, 30 minutes
- 90834: Psychotherapy, 45 minutes
- 90837: Psychotherapy, 60 minutes
- 90846: Family psychotherapy without the patient
- 90847: Family psychotherapy with the patient
Modifiers: Modifiers provide additional information about the service. For telehealth:
- Modifier 95: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.
- Modifier GT: Via interactive audio and video telecommunications systems (used by some payers).
Place of Service (POS) Codes: Indicate the setting where the service was provided.
- POS 02: Telehealth provided other than in patient’s home.
- POS 10: Telehealth provided in patient’s home.

Differences Between Telehealth and In-Person Billing

While the core billing principles remain consistent, telehealth introduces nuances:

Documentation: Must reflect that the service was provided via telehealth, including the technology used and patient consent.
Reimbursement Rates: Some payers may have different rates for telehealth services compared to in-person visits.
Licensure: Providers must be licensed in the state where the patient is located during the telehealth session.

Navigating Insurance and Reimbursement

Medicare and Medicaid Telehealth Billing Policies

Medicare has expanded its telehealth coverage, especially for mental health services. Key points include:

Coverage: Medicare covers telehealth services for mental health, including psychotherapy and counseling.
Audio-Only Services: Medicare covers certain audio-only mental health services, recognizing accessibility challenges.
In-Person Requirement: Starting January 1, 2025, an in-person visit within six months prior to the telehealth service may be required.

Medicaid policies vary by state, so it's essential to consult state-specific guidelines for telehealth billing.

Private Insurance Considerations

Private insurers have diverse policies regarding telehealth:

Parity Laws: Some states have laws requiring private insurers to reimburse telehealth services at the same rate as in-person services.
Coverage Variability: Coverage for telehealth services can differ among insurers; always verify patient benefits before service delivery.

Common Challenges and Solutions

Challenge: Claim denials due to incorrect modifiers or POS codes.
- Solution: Regular training and audits to ensure billing accuracy.
Challenge: Staying updated with changing regulations.
- Solution: Subscribe to updates from CMS, AMA, and professional associations.
Challenge: Managing multi-state licensure requirements.
- Solution: Utilize resources like the Psychology Interjurisdictional Compact (PSYPACT) for cross-state practice.

Best Practices for Telehealth Billing

Accurate Documentation and Coding

Thorough documentation is vital:

Note the start and end times of sessions.
Specify the technology used (e.g., Zoom, Doxy.me).
Confirm patient identity and location at the time of service.
Document patient consent for telehealth services.

Staying Updated with Regulatory Changes

Telehealth regulations are dynamic:

Regularly review updates from CMS and state Medicaid programs.
Participate in webinars and training sessions offered by professional organizations.
Engage with billing experts or consultants specializing in telehealth.

Utilizing Technology and Billing Software

Investing in robust billing software can streamline processes:

Choose platforms that integrate telehealth scheduling, documentation, and billing.
Ensure the software is updated with the latest CPT codes and modifiers.
Utilize features that flag potential billing errors before claim submission.

Final Thoughts

Telehealth has become an integral part of mental health care delivery, offering flexibility and expanded access to services. However, the complexities of telehealth billing require mental health practices to be diligent, informed, and adaptable.

By understanding the fundamentals, staying abreast of regulatory changes, and implementing best practices, mental health professionals can navigate telehealth billing with confidence. Embracing these practices not only ensures financial stability but also allows providers to focus on their primary mission: delivering exceptional care to those in need.