COVID-19 opened many doors for Telemedicine. In the past, insurance payers often had difficulty processing claims with telehealth modifiers, even though modifiers for telemental health have been widely available for some time. Many insurance payers have the capability to process these claims if you follow their requirements. These changes are rapidly occurring; and as the Public Health Emergency (PHE) ends, we will begin to see more permanent policies.
It is important to check with your insurance payers to see what specific requirements they have for the claim processing. If you have specific questions about how to submit claims to a certain payer, it is best to reach out to the network provider representative assigned to you for that insurance payer.
Many insurance payers reimburse for sessions conducted via synchronous audiovisual communication, which means seeing the client using a video telecommunications platform (VTC). Some insurance payers reimburse for telephone sessions without video; however, that circumstance varies from payer to payer.
How to Bill your TeleMental Health Claim
Place of Service (POS): This is in Box 24b on a standard CMS-1500 form
- POS 02: Telemedicine Provided Other than in a Patient’s Home
o Description: The location where health services and health-related services are provided or received through telecommunication technology. Patients are not located in their home when receiving health services or health-related services through telecommunication technology (effective January 1, 2017) (description change effective January 1, 2022, and applicable for Medicare April 1, 2022).
o This is the preferred POS to use for private insurance to ensure reimbursement.
- POS 11: Office Visit
o Description: This location is reported if the location is somewhere other than a hospital; skilled nursing facility (SNF); military treatment facility, community health center; state or local public health clinic; or intermediate care facility (ICF) where the health professional consistently delivers health examinations, diagnoses, and the treatment of diseases or injuries on an ambulatory basis.
o This POS was used early on during the PHE while insurance payers were updating their systems to accept POS 02 and related modifiers.
o Some insurance payers are still requiring the use of POS 11 instead of POS 02 if the proper modifier shows that the session was a virtual visit. It is important to check with your provider representative if you have questions on what POS to use.
- POS 10: Telemedicine Provided in Patient’s Home
o Description: The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology (this code is effective January 1, 2022, and available to Medicare April 1, 2022).
o POS 10 is new, so insurance payers have not updated their policies to include this POS. Experience shows us that insurance payers will warn you ahead of time via newsletters about when they will begin implementing new POS for telemedicine claims provided to a patient while the patient is located at their residence. Until then, it is best to continue to monitor this possible upcoming change and prepare for it.
Telemedicine Modifiers Audio & Visual. The modifier will need to land in Box 24d on a standard CMS-1500 form
- GT is the preferred modifier by most insurance payers.
- 95 is still used in some states as the preferred modifier. Check with the Provider Relations department to see what that insurance payer requires.
Telemedicine Modifier Audio Only
- FQ modifier is being released for audio-only services as of 1/1/2022; however, because this modifier is so new, your insurance payer is likely not able to process a claim with this modifier. It will take time before this modifier is regularly reimbursed. This is yet another thing that needs to be brought up with a provider representative.
While private insurance providers have their own policies on how to handle telemedicine, most insurance payers are following the guidelines listed on https://www.cms.gov/. If you have additional questions regarding private insurance policies and what is required for a claim, then reach out to their Provider Relations Representative.
Different codes are used for PHP, IOP (Intensive Outpatient Program), ABA, EAP, Outpatient, Inpatient, Opiate Treatment, and other services.
CPT Codes commonly covered via video sessions
- 90785 Psytx Interactive Complexity
- 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
- 90839 Psytx crisis initial 60 min
- 90840 Psytx crisis ea addl 30 min
- 90845 Psychoanalysis
- 90846 Family psytx w/o patient
- 90847 Family psytx w/patient
- 90853 Group psychotherapy
- G0396 Alcohol/subs interv 15-30mn
- G0397 Alcohol/subs interv >30 min
- G0443 Brief alcohol misuse counsel
- G0444 Depression screen annual
- G2086 Off base opioid tx first m
- G2087 Off base opioid tx, sub m
- G2088 Off opioid tx month add 30
Stay up-to-date with changes to the telemental health field by taking our Telehealth Billing: 2023 Update course.
Need assistance or consultation for your insurance billing? Contact us for a consultation meeting.
By: Zaynab Hamka, Billing Consultant
Nicoletti, B. (2022, February 3). Coding telehealth visits. https://codingintel.com/coding-telehealth-visits/#
Coding Intel. (2022, February 8). Payment for telephone calls during the PHE: CMS update. https://codingintel.com/payment-for-phone-calls-cms-update/