With telehealth’s expansion during the COVID-19 pandemic to avoid the need to travel or congregate, CMS covers more than 80 additional services. Under the 2020 CARES Act signed into law on March 6, 2020, geographic and originating site Medicare telehealth reimbursement restrictions were waived for mental health services overall, during certain emergency periods. New codes for psychological services were added for the public health emergency (PHE), with federal policy changes varying by state. Medical billing companies help providers report their telehealth services using the new codes and meet state and payer guidelines. Companies with extensive experience in the field have the expertise and technology to simplify processes, and enable physicians to improve patient care and take advantage of the new revenue opportunities.
Video-based telepsychiatry allows patients to benefit from convenient, affordable and readily-accessible mental health services. Services that can be billed when provided via telehealth are: Psychological and neuropsychological testing, group psychotherapy, developmental screening, and adaptive behavior assessment and treatment. Providers of telemental health services should ensure that care delivered telemedicine meet the same standards as in-person care. Telemental health services require appropriate documentation and coding specifying when they are provided.
Telehealth Codes for Psychiatric Services
The CPT codes to report psychiatric services provided via telemedicine with modifier 95 appended are:
90785 Psychiatric interactive complexity
90791, 90792 Psychiatric diagnostic services
90832, 90833, 90834, 90836, 90837, 90838 Psychotherapy services
90839, 90840 Crisis services
90846, 90847 Family therapy services
96116 Neurobehavioral status examination
99201-99205 Outpatient new patient visit
99211-99215 Office outpatient E/M visit
99231-99233 Subsequent hospital care
99354-55 Prolonged service outpatient visit
99356-57 Prolonged service inpatient
Billing Medicare for Telehealth Services
Telehealth services are reimbursed at the same rate as in-person visits. Mental and behavioral health services that can be provided via telehealth are grouped in three categories (www.apaservices.org):
- CPT Codes Allowed via Phone Only and Traditional Telehealth
Diagnostic Interview (90791, 90792)
Psychotherapy (90832, 90833, 90834, 90836, 90837, 90838)
Group Psychotherapy (90853)
Family Psychotherapy (90846, 90847)
Crisis Intervention and Interactive Complexity (90839, 90840, 90785)
Neurobehavioral Status Exam (96116, 96121)
Psychological Evaluation (96130, 96131)
Neuropsychological Evaluation (96132, 96133)
Psychological & Neuropsychological Test Administration & Scoring ( 96136, 96137, 96138, 96139)
Health Behavior Assessment (96156)
Health Behavior Intervention, Individual (96158, 96159)
Health Behavior Intervention, Group (96164, 96165)
Health Behavior Intervention, Family with patient (96167, 96178)
Behavioral Screening (96127)
Screening, Brief Intervention, and Referral to Treatment (G0396, G0397)
- CPT Codes Allowed via Traditional Telehealth Only
For traditional telehealth, telephones may be used only with audio and video functions that provide two-way real-time interactive communication:
- Developmental Screening and Testing (96110, 96112, 96113)
- Adaptive Behavior Assessment (97151, 97152, 0362T)
- Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373T)
- CPT Codes Added to Telehealth List as Non-Covered Services (not reimbursable in Medicare):
- Psychophysiological therapy (90875)
- Health Behavior Intervention, Family without patient (96170, 96171)
Telehealth Psychological and Neuropsychological Testing Services
CMS telehealth codes for Psychological and Neuropsychological Testing, which are temporary additions for the PHE for the COVID-19 pandemic are as follows:
96130 psychological testing evaluation services by physician or other healthcare professional, one hour
96131 psychological testing evaluation services by physician or other healthcare professional, each additional hour
96132 neuropsychological testing evaluation services by physician or other qualified healthcare professional, one hour
96133 neuropsychological testing evaluation services by physician or other qualified healthcare professional, each additional hour
96136 psychological and neurological testing phy/qhp 1s
96137 psychological and neurological testing phy/qhp emotional assessment
96138 psychological and neurological tech phy/qhp emotional assessment
96139 psychological and neurological testing tech emotional assessment
Telemedicine Services for Psychiatry – Points to Note
- Telehealth services can now be provided to both new and established Medicare patients.
- Psychologists may provide telehealth services from their home.
- Medicare patients can now receive telehealth services in their own homes as well as in any health-care facility.
- When using live videoconferencing to facilitate a patient encounter, the same CPT codes should be used as for an in-person visit, but with the Place of Service (POS) appropriate for the specific encounter.
- For the duration of this emergency declaration, HHS has waived HIPAA penalties for using non-HIPAA compliant video conferencing software and allows conduct telehealth sessions via video platforms such as Skype (basic) and FaceTime.
- CMS allows for patient-initiated “brief check-ins” via telephone, of duration 5 – 10 minutes.
- On April 30, 2020 (retroactive to March 1, 2020), CMS started permitting audio only telephone care for the following psychiatry codes: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853.
- CMS has also increased reimbursement for audio-only telephone visits, CPT 99441-3 (rules may vary by locality and specific payers).
- Psychologists can bill for assessment and management services using codes 98966-68.
- Visits to patients in nursing homes may be conducted via telehealth.
- Visits to inpatients and skilled nursing facility residents can be provided not just once every 30 days, but as needed.
- Cost-sharing for telehealth visits may be reduced or waive during this emergency period. This does not apply to brief communication e-Visits.
Just as Medicare does, most commercial payers have also updated their policies to include telehealth visits through the duration of the public health emergency. Partnering with an expert medical billing service can help providers navigate the complexities of coding and billing telepsychiatry services in these challenging times.