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TeleMental Health Reimbursement

By Ofer Zur, Ph.D.
 

 

 

 Reimbursements
Telemedicine is Reimbursable
Retrieved from: www.breakthrough.com/overview

Since 2004, Medicare and the AMA have issued CPT codes to identify and reimburse telepsychiatry and online counseling services. A list of eligible services and codes include:

  • Individual psychotherapy: CPT 90804 - 90809
  • Consultations: CPT 99241 - 99255
  • Office or other outpatient visits: CPT 99201 - 99215
  • Pharmacologic management: CPT 90862
  • Psychiatric diagnostic interview examination: CPT 90801
  • Neurobehavioral status examination: CPT 96116

 
Your Medicare Benefits
Source: https://www.medicare.gov/coverage/telehealth.html

Medicare Part B covers certain telehealth services, like office visits and consultations that are provided using an interactive two-way telecommunications system (like real-time audio and video) by an eligible provider who is at a location different than the patient. Telehealth is available in some rural areas, under certain conditions, and only if the patient is located at one of the following places: a doctor's office, hospital, critical access hospital, rural health clinic, federally-qualified health center, hospital- based or critical access hospital-based dialysis facility, skilled nursing facility, or community mental health center. YOU pay 20% of the Medicare-approved amount for the doctor's services.

 
Fact Sheet: Telehealth Services, By CMS
Retrieved from: www.telemedicine.com/pdfs/TelehealthSrvcsfctsht.pdf

Opening Statement of the Brochure
Medicare will pay for a limited number of Part B services that are furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for a face-to-face, "hands on" encounter.

Distant Site Practitioners
Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are:

  • Physicians;
  • Nurse practitioners (NP);
  • Physician assistants (PA); Nurse midwives;
  • Clinical nurse specialists (CNS);
  • and Registered dietitians or nutrition professionals.
  • Clinical psychologists (CP) and clinical social workers (CSW) (CPs and CSWs cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for Current Procedural Terminology [CPT] codes 90805, 90807, and 90809);

Telehealth Services
As a condition of payment, an interactive audio and video telecommunications system must be used that permits real-time communication between the physician or practitioner at the distant site and the beneficiary at the originating site. Asynchronous "store and forward" technology is permitted only in Federal telehealth demonstration programs conducted in Alaska or Hawaii.

The current list of Medicare telehealth services includes:

  • Consultations (CPT codes 99241 - 99255);
  • Office or other outpatient visits (CPT codes 99201 - 99215)
  • Individual psychotherapy (CPT codes 90804 - 90809);
  • Pharmacologic management (CPT code 90862);
  • Psychiatric diagnostic interview examination (CPT code 90801);
  • Individual medical nutrition therapy (Healthcare Common Procedure Coding system [HCPCS] code G0270 and CPT codes 97802 - 97803);
  • Neurobehavioral status examination (CPT code 96116); and
  • Follow-up inpatient telehealth consultations (HCPCS codes G0406, G0407, and G0408).
  • End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment (CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961);

 
Think You Can't Afford Therapy? Think Again
Source http://blog.breakthrough.com

Psychotherapy has been shown to help 90% of people who receive it, yet most who would benefit from it don't go, largely because of the perceived costs. However, online counseling, a form of telehealth, can cut costs (as much as 50% in some cases), and is now more affordable than ever due to new regulations on insurance reimbursement: you can now search for a therapist, preview their services, have a therapy session, and file your insurance claim, all without ever leaving home. The American Psychological Association today issued an update on reimbursement of telehealth.

Currently:

  • Over 100 private payers reimburse telemental health, with Blue Cross/Blue Shield being a leader.
  • Medicare will reimburse live telemental health sessions at in-person rates when the client is in a qualifying location (generally a rural medical office). We've also heard they are working to expand these covered scenarios.
  • Medicaid leaves telehealth reimbursement policies to its state offices, 35 of which currently reimburse in some form.
  • Twelve states require reimbursement of telemental health: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas, and Virginia.
  • With these new regulations, it is hoped that more of the 57 million Americans who would benefit from mental health services will be able to access them.

 
Insurance & Billing

Insurance, Billing, Reimbursement & CPT Codes in Online Therapy, E-Therapy & TeleMental Health

 
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