Telehealth billing for therapists is complex, requiring the correct medical claims coding cpt codes, modifiers, and place of service code. Our exhaustive guide to telehealth billing for therapists will teach you how to code your mental health insurance claims for telehealth billing as the process to ensure you get paid every time. We will also go through major insurance brands like Medicare, Medicaid, etc, and their telehealth billing guidelines.
2021 Note: While telehealth billing for therapists and psychologists has not changed since 2020, the fee schedules, patient responsibility payments, and eligibility and benefits of many plans have. Please make sure to for eligibility and benefits for your 2021 telehealth billing for therapists.
Telehealth Billing for Psychotherapy: An Introduction
Telehealth billing for therapists is an obvious need. Providers want to help clients who are unable to attend in person therapy for whatever reason: fear, disability, distance, or simply for ease of scheduling.
For whatever reason, insurance companies have pushed back against telehealth for psychotherapy.
Our guide will show you how to ensure you get approved for telehealth billing for mental health claims, how to bill the claims with the right mental health CPT codes for telehealth, telehealth modifier, and place of service code.
If you’re struggling with getting paid for telehealth sessions and don’t want to deal with the hassle, consider reaching out about our mental health billing service. We handle this headache for you.
How to Always Get Approved for Mental Health Telehealth Billing
To ensure you get reimbursed for providing telehealth psychotherapy, always call each client’s insurance plan and ask about approval for telehealth therapy.
We have an exhaustive script on how to verify eligibility and benefits, but here are the highlights:
- Gather the necessary information: the client’s demographic and insurance information, your NPI and Tax ID.
- Review the back of the client’s insurance card. Call the Provider customer support number or mental health number. It might also be listed as precerification or the number for eligibility and benefits.
- Ask to check “eligibility and benefits for outpatient mental health benefits”.
- Give them your NPI, tax ID, and office location.
- Give the client’s Name, date of birth, and Subscriber ID.
- Ask if you are in-network or out-of-network with the client’s plan.
- Ask if they have approval for telehealth sessions. If they do, ask about and write down the modifier that insurance company requires you to use (either 95 or GT).
- If they do not have approval, ask how to obtain approval for telehealth sessions.
- Confirm the claims submission information: claims address and payer ID.
- Ask for a reference number for your phone call. Record the date, time, representative’s name, and reference number for the call.
Telehealth Billing for Therapists Checklist
Every insurance company processes telehealth billing for therapists differently, so make sure to ask which CPT code and telehealth modifier to use.
Authorization may be required; if so, also ask for the authorization number associated with the telehealth sessions.
Almost all insurance companies utilize Place of Service code 02 for telehealth but this is also worth confirming.
This is the only way to guarantee you will be reimbursed for telehealth billing for mental health therapy.
If this process sounds excessive, we do this for you for free as part of our mental health billing service for therapists.
Telehealth CPT Codes for Psychotherapy
This is a common misconception! While there are technically legacy CPT codes for teleleath therapy, these are not often used:
- 98968 – Telephone therapy (non-psychiatrist) – limit 3 units/hours per application.
- 99443 – Telephone therapy (psychiatrist) – limit 3 units/hours per application
We strongly recommend against using these telehealth CPT codes for therapy when billing.
Instead, you want to utilize normal mental health procedure codes listed below and use the appropriate CPT code modifier (95 or GT) with the correct place of service code (02).
These codes are approved for mental health telehealth billing by both the current procedural terminology (CPT) and the Centers for Medicare Services (CMS):
- 99201 – 99215 – Evaluation and Management Service Codes
- 90791 & 90792 – Diagnostic Interview
- 90832 – Psychotherapy for 30 Minutes
- 90834 – Psychotherapy for 45 Minutes
- 90837 – Psychotherapy for 55+ Minutes
- +90836 – Add On CPT Code for Individual Psychotherapy
- +90838 – Add On CPT Code for Individual Psychotherapy when Preformed with Evaluation and Management Services
- 90845 – Psychoanalysis
- 90846 – Family Psychotherapy without the patient present
- 90847 – Family Psychotherapy with the patient present
If you’re not sure which CPT code to use, consider hiring our billing service to demystify the process.
Telehealth CPT Code Modifiers: 95, GT, GQ, G0
The correct insurance billing modifier to use for telehealth billing for therapists depends on the guidelines of the insurance company you’re billing.
We’ll cover the four telehealth modifiers for insurance billing with an emphasis on the two most popular codes, “95” and “GT”.
CPT Code Modifier 95
The American Medical Association (AMA) launched in 2017, this CPT code is the most common modifier used by commercial insurance policies. (Source)
This modifier’s description is for “Synchronous Telemedicine Services Rendered via Real-Time Interactive Audio and Video Telecommunications Systems”.
Quoting Page 730 of the American Medical Associations “CPT 2017 Professional Edition”:
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located at a distant site from the physician or other qualified healthcare professional.
The totality of the communication of information exchanged between the physician or other qualified healthcare professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.
Modifier 95 may only be appended to the services listed in Appendix P. Appendix P is the list of CPT® codes for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
What’s important to note here is that this code was created to replace CPT modifier “GT” but quite often “GT” is still utilized.
Synchronous telemedicine services are real-time and interactive, meaning they are describing the services mental health providers are rendering via 99.9% of telehealth billing cases.
This differs from asynchronous services which would be the utilization of telecommunication to transfer medical information from one system to another (yes, they somehow have a code for this).
Telehealth psychotherapy is always synchronous. Here us a list of CPT codes that where Modifier 95 can be utilized: list.
CPT Code Modifier GT
Utilizing telehealth billing modifier GT is exactly the same as modifier 95 in the services it describes. This is simply a legacy code that many insurance companies still utilize.
Medicare originally utilized the GT CPT code modifier but in November of 2017 announced they no longer require any telehealth modifier to be added to their claims (instead just post Place of Service code 02) (Source).
CPT Code Modifier GT describes Synchronous Telemedicine Services provided in real time in the same manner as a typical face-to-face session.
The CPT code that you choose describes the procedure taking place in session. The modifier you use designates that this session took place via a real-time audio or video telecommunications system.
Not sure if you should use GT or 95? We can help find out for you for free.
CPT Code Modifier GQ
This modifier is used for “store and forward” technologies or asynchronous telemedicine services that are not provided in real time. We can safely say this is never a modifier you’ll use for telehealth billing for mental health.
Most often this is for forwarding over X-rays, MRIs, lab results, audio clips, and text.
CPT Code Modifier G0 (G and Zero)
The G0 telehealth modifier is used in incredibly rare cases specifically to describe the assessment of a stroke at a distance. Source
Telehealth Place of Service Code
The place of service code for most sessions are set in an office as “11” but for telehealth sessions the place of service code is “2”. The place of service code is posted on the CMS1500 under Box 24 section B.
How to Code Telehealth Insurance Claims for Mental Health: Visual Guide
Include all normal CMS1500 claim information but on Box 24, utilize the the more accurate CPT codes, place of service code, and modifier depending on the guidelines of your insurance company.
This example shows an intake session (CPT code 90791) taking place on 1/1/2020 with the Place of Service code “02” and the modifier “95”. Again, if your insurance company requires using GT instead of 95, use GT. Always call to ask per insurance company so you know how to code your claim perfectly.
And of course, if you are fed up with telehealth billing for therapists like yourself, which modifier to use, how to code your claims, or just dealing with insurance in general, feel free to inquire about our mental health billing service at TheraThink. We take care of all of these situations for you!
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