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Telehealth Certification Institute, LLC

Medicare Reimbursement for TeleHealth

The Centers for Medicare & Medicaid Services (CMS), HHS published their final rule for 2018 stating the changes to the Medicare physician fee schedule(PFS) and other Medicare Part B payment policies. 

Click here to see the final rule.

Here is a summary of the important updates for behavioral health providers.  However, DO NOT consider this as guidance for your Medicare billing.  We advise that you consult directly with the Centers for Medicare & Medicaid Services (CMS) for guidance and to ensure the accuracy of your billing practices. 

Conditions for billing and payment for telehealth services:

To be reimbursed for telehealth services, the service must be on the approved list.

To view the approved list of telehealth services click here and select the most recent regulation number and then click on the following item “CY 2018 List of Medicare Telehealth Services”.

Also, all of the following requirements must be met (taken directly from the final rule):

● The service must be furnished via an interactive telecommunications system.

(audio and video equipment permitting two-way, real-time interactive

Communication)

● The service must be furnished by a physician or other authorized practitioner.

(At this time Counselors and Marriage and Family Therapists are working to be added as authorized practitioners)

● The service must be furnished to an eligible telehealth individual.

● The individual receiving the service must be located in a telehealth originating site.

(The originating site is the location of the client and the distant site is the location of the clinician.  Approved originating sites are those located in rural health professional shortage areas (HPSAs) or in a county that is not included in a metropolitan statistical area (MSA).)

 

Claims are to be submitted to the Medicare Administrative Contractors (MACs) that process claims for the service area where their distant site is located.

 

Payment Parity:

“Section 1834(m)(2)(A) of the Act requires that a practitioner who furnishes a telehealth service to an eligible telehealth individual be paid an amount equal to the amount that the practitioner would have been paid if the service had been furnished without the use of a telecommunications system.”

No more GT modifier.  Now that the place of service 02 is used to designate telehealth the GT modifier is not needed (with the exception CAH Method II billing).

TeleMental Health Codes include:

90785    Psytx complex interactive            

90791    Psych diagnostic evaluation        

90792    Psych diag eval w/med srvcs      

90832    Psytx pt&/family 30 minutes      

90833    Psytx pt&/fam w/e&m 30 min   

90834    Psytx pt&/family 45 minutes      

90836    Psytx pt&/fam w/e&m 45 min   

90837    Psytx pt&/family 60 minutes      

90838    Psytx pt&/fam w/e&m 60 min                   

90845    Psychoanalysis 

90846    Family psytx w/o patient              

90847    Family psytx w/patient 

Two new codes:

90839    Psytx crisis initial 60 min             

90840    Psytx crisis ea addl 30 min

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