Telehealth Medicare Billing for Therapy and Mental Health Providers

Telehealth medicare billing for therapy isn't too complex, fortunately for mental health providers.  Our guide to Medicare insurance billing for telehealth will help you learn the CPT codes, modifiers, and license you need to bill Medicare for telehealth psychotherapy.

Medicare Telehealth Billing Guidelines

The following are guidelines created by the Centers for Medicare Services (CMS) that apply to all providers.

Medicare Telehealth Claims Coding Requirements:

  • Sessions must be submitted using the appropriate CPT codes (see below).
  • Sessions must also be submitted using the correct Place of Service code: 02.

telehealth place of service code 02

While Medicare used to require the telehealth modifier “GT”, as of 2017, Medicare no longer requires submission with the GT modifier.  (Source).  Instead only the Place of Service code of 02 is required.

Medicare Telehealth Service Requirements

In 2019, Medicare expanded telehealth coverage for substance abuse or a co-occurring mental health disorder.  These sessions are allowed to take place while the client is at their home.  (Source)

medicare telehealth billing for therapy

Starting in 2020, Medicare Advantage plans are allowed to offer more telehealth benefits than Medicare Part B.  (Source)

As per their guidelines:

“Medicare telehealth services include office visits, psychotherapy, consultations, and certain other medical or health services that are provided by an eligible provider who isn’t at your location using an interactive 2-way telecommunications system (like real-time audio and video).”

As of 2020, Medicare treatment for a novel Coronavirus has expanded services and service locations.  (Source).  Clients suffering from a Covid-19 diagnosis can be treated from any service location.

Without a Covid19 diagnosis, Medicare only allows telehealth services if you were located at certain locations:

  • A doctor’s office
  • A hospital
  • A critical access hospital (CAH)
  • A rural health clinic
  • federally qualified health center
  • A hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center

Note:  The Coronavirus outbreak in the United States is a dynamic, changing-by-the-day phenomenon.  We expect many of these regulations to change.

Licenses Approved for Medicare Telehealth Billing

  • Physicians
  • Nurse Practitioners (NPs)
  • Physician assistants (PAs)
  • Nurse-midwives
  • Clinical nurse specialists (CNSs)
  • Certified registered nurse anesthetists
  • Clinical psychologists (CPs) and clinical social workers (CSWs)
    • CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.
  • Registered dietitians or nutrition professional

Medicare Telehealth Guidelines for Therapy and Mental Health Providers

The following mental health telehealth CPT codes are approved for behavioral health providers:

  • 99201 – 99215 — Office or other outpatient visits, evaluation and management
  • 96150 – 96154 — Individual or group health and behavior assessment and interventions
  • 90832 – 90838 — Individual psychotherapy
  • G0459 — Telehealth pharmacological management
  • 90791 – 90791 — Psychiatric diagnostic interview examination
  • 96116 — Neurobehavioral status examination
  • G0396, G0397 — Alcohol or substance abuse (other than tobacco) structured assessment or intervention
  • G0444 — Annual depression screening, 15 minutes
  • G0446 — Annual intensive behavioral therapy for cardiovascular disease, 15 minutes
  • G0447 — Behavioral counseling for obesity, 15 minutes
  • 90845 — Psychoanalysis
  • 90846 — Family psychotherapy without the patient present
  • 90847 — Family psychotherapy with the patient present
  • 96160, 96161 — Health risk assessment
  • 90839, 90840 — Psychotherapy for crisis

Sources:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10152.pdf

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf