What you need to know about billing for telehealth

Is billing for telehealth different from in-office visits?

There are a few distinctions in how to bill insurance for telehealth appointments. While you’ll likely use the same CPT codes as you would for an in-person appointment, you’ll also need to provide additional details to insurance payers in your claim. For example, you’ll need to add a place of service (POS code) along with a modifier add-on code for telehealth appointments.

Payers may vary in their specific requirements, so always work closely with insurance companies to be sure you are filing claims correctly. Headway makes this process easy for providers by adding the POS to the claim ahead of time, so the only thing you need to do is document where the visit took place. Headway also reviews the payer documentation guidelines so our therapy templates have all of the required components.

What services can be provided via telehealth appointments?

As a general rule, you should be able to provide any mental health service you can offer in person through telehealth (including, for example, crisis therapy). During the pandemic, many insurance payers — including Medicare — created waivers allowing telehealth appointments. Many of these waivers are still in place, making therapy more accessible for many clients and more efficient for providers. However, you should still check regulatory requirements, including local or state requirements, to make sure of this.

Telehealth reimbursement rates

Telehealth reimbursement rates vary depending on several factors, including the service you provide, the insurance contract, and your geographic location.

Many states have parity laws requiring insurance to cover telehealth services as they would in-person services. Some states also have laws requiring payers to reimburse these services at the same rates. Every state is different; some pay 80 to 90 percent of in-person rates.

Code differences for telehealth

Places of service (POS) telehealth codes

When providing telehealth services, you’ll need to make note of your client’s location during the time of therapy. You can learn more about POS codes via the Centers for Medicare & Medicaid Services (CMS).

Below are common examples of POS telehealth codes used by therapists:

10: Telehealth provided in a patient’s home
11: Telehealth provided in an office
12: Telehealth provided in a private residence other than a hospital or other facility
13: Telehealth provided in an assisted living facility
14: Telehealth provided in a group home

Telehealth CPT codes

While there are some CPT codes specific to telehealth, providers do not often use them. Instead, it’s more common to use normal mental health procedure codes along with a CPT code modifier and place of service code. The following CPT codes are approved for mental health telehealth billing:

99201 - 99215: Evaluation and Management Service Codes
90791 and 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 with E/M Services
90845: Psychoanalysis
90846: Family Psychotherapy without the patient present
90847: Family Psychotherapy with the patient present

Modifiers for telehealth appointments

Rather than using telehealth-specific codes, most mental health providers add modifiers to standard CPT codes when billing for telehealth. There are two primary modifiers that can be used for telehealth appointments.

The most common modifier for telehealth appointments is CPT code modifier 95, which covers synchronous telemedicine rendered via real-time, interactive audio-visual systems (such as Zoom or Doximity). CPT code modifier GT functions essentially the same, but is geared toward larger organizations (like hospitals). Since Medicare stopped accepting code modifier GT, this code has become less common.

As a best practice, check with your insurance payer to determine which modifier code to use when filing telehealth insurance claims. Headway providers don’t need to include modifiers, as we take care of this portion of billing for you.

Billing and coding