Medicare mandates the technology used, specific codes and the beneficiary's location. Be sure you meet all requirements.
Telehealth in Medicare allows psychologists to bill for services furnished to a Medicare beneficiary via a telecommunications system. Telehealth is only available for Part B services furnished to beneficiaries enrolled in fee-for-service Medicare and is subject to state law.
Several requirements must be met for a psychologist to bill for telehealth services:
The service must be provided using an interactive audio and video telecommunications system that permits real-time communication between the psychologist (at the distant site) and the beneficiary (at the originating site).
Location of Beneficiary
The beneficiary must be located at an “originating site” at the time the services are furnished via a telecommunications system. Originating sites authorized by law include a:
• Healthcare professional’s office
• Critical Access Hospital (CAH)
• Rural Health Clinic
• Federally Qualified Health Center
• Hospital-based or CAH-based Renal Dialysis Center (including satellites)
• Skilled Nursing Facility (SNF), or
• Community Mental Health Center (CMHC).
A Medicare beneficiary’s home does not qualify as an originating site.
The originating site must be located in either a rural Health Professional Shortage Area (HPSA) or in a county outside of a metropolitan statistical area. This limits the number of Medicare beneficiaries who can utilize telehealth, as about 80 percent reside in metropolitan areas. There is one exception: places that participate in an approved federal telehealth demonstration project are considered originating sites no matter where they are located.
Medicare telehealth includes 17 mental and behavioral health services:
• 90785 Interactive complexity (Note: This service must be listed separately in addition to the code for primary procedure)
• 90791 Psychiatric diagnostic evaluation
• 90832 Psychotherapy, 30 minutes with patient
• 90834 Psychotherapy, 45 minutes with patient
• 90837 Psychotherapy, 60 minutes with patient
• 90839 Psychotherapy for crisis, initial 60 minutes*
• 90840 Psychotherapy for crisis; each additional 30 minutes (Note: This service must be listed separately in addition to the code for primary procedure)*
• 90845 Psychoanalysis
• 90846 Family psychotherapy (without the patient present)
• 90847 Family psychotherapy (conjoint psychotherapy) (with the patient present)
• 96116 Neurobehavioral status examination
• 96150 Health and Behavior initial assessment
• 96151 Health and Behavior re-assessment
• 96152 Health and Behavior intervention, individual
• 96153 Health and Behavior intervention, group (2 or more patients)
• 96154 Health and Behavior family intervention with the patient present
• 96160 Patient-focused health risk assessment
• 96161 Caregiver-focused health risk assessment
* The addition of the Psychotherapy for crisis codes to the telehealth list in 2018 includes the CMS clarification that payment for these services via telehealth is explicitly conditioned upon the remotely located practitioner having the ability to mobilize resources (i.e. communicate with and inform staff) at the originating site to diffuse the crisis and restore safety, when applicable.
Also effective in 2018, CMS has eliminated the requirement of the modifier “GT” on professional claims for telehealth services. Instead, psychologists should use the telehealth Place of Service (POS) Code 02, which certifies that the service meets the telehealth requirements (i.e. the service was furnished through an interactive audio and video telecommunications system)..
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