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Insurance Reimbursement for TeleMental Health:

Telemedicine, Including TeleMental Health, Codes for ‘Modifier',
CPT Codes, and Place of Service

By Ofer Zur, Ph.D.

This page is part of an online CE course
TeleMental Health: The New Standard - Ethical, Legal, Clinical, Technological, and Practice Considerations


Note: It is important to check with the insurance plan to determine whether telemental health services are covered and, if they are, which codes should be used to cover different types of telemental health services.

Modifier for synchronous telemedicine service

In 2017 there is a new CPT modifier, 95, for "synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system." Phone sessions are not included under the "95" modifier. The 2017 CPT manual has a new Appendix P that lists 79 standard CPT codes for which a "95" modifier can be used to indicate that the service was provided via a real-time, interactive audio and video telecommunications system. While this modifier will cover video sessions, you'll notice this description doesn't apply to phone sessions.

The psychotherapy services that CPT designates as appropriate for telemedicine

90832 psychotherapy, 30 minutes with patient.
90834 psychotherapy, 45 minutes with patient.
90837 psychotherapy, 60 minutes with patient.
90845 psychoanalysis.
90846 family psychotherapy (without the patient present), 50 minutes.
90847 family psychotherapy (with the patient present), 50 minutes 90863.

Place of Service

02 is the code for "the location where health services and health related services are provided or received, through a telecommunication system". It took effect January 1, 2017. (See CMS info).

Eligibility for Reimbursement for TeleMental Health

It is very important to check with the insurance plan to see whether telemental health services are covered and, if they are, which code should be used for the type of service provided.

Note that Medicare is one of the largest payers for telehealth services, especially those delivered to Medically Underserved Areas (MUAs.)

EAP services through TeleMental Health

A large number of EAP programs actively recruit telemental health practitioners to supply EAP services remotely. To find these programs, you can contact major employers in your area or inquire with your local chapter of the Employee Assistance Professionals Association (EAPA.)

For updates and more information

The American Medical Association revises coding manual for 2017

Additional resources regarding Insurance, Billing, Reimbursement & CPT Codes in E-Therapy & TeleMental Health

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