Each year, the Center for Medicare and Medicaid Services (CMS) adds new procedural codes for telemental health insurance billing and reimbursement. Changes in these procedural codes for 2015 were just released, and several new changes have benefited the behavioral and mental health arenas. (See this page for more information about Current Procedural Terminology (CPT) code sets.)
Services that Get Paid
With telemental health CPT codes, services are still being reimbursed only for Health Provider Shortage Areas (HPSAs). Health Resources and Services Administration has developed a website tool to provide assistance to potential originating sites to determine their geographic status. To access this tool, see the CMS website. Several other conditions must be met in order for Medicare payments to be made for telehealth services. Specifically, the service must be on the list of Medicare telehealth services and meet all of the following additional requirements for coverage:
● The service must be furnished via an interactive telecommunications system.
● The practitioner furnishing the service must meet the telehealth requirements, as well as the usual Medicare requirements.
● The service must be furnished to an eligible telehealth individual.
● The individual receiving the services must be in an eligible originating site. When all of these conditions are met, Medicare pays an originating site fee to the originating site and provides separate payment to the distant site practitioner furnishing the service.
Procedures Currently Reimbursable for Telemental Health
- Individual psychiatric interview
- Individual psychotherapy
- Individual & group health & behavior assessment & intervention
- Neurobehavioral status examination
- Pharmacologic management
- Smoking cessation
- Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST) and brief intervention, 15 to 30 minutes and intervention greater than 30 minutes, respectively.
- Annual alcohol misuse screening, 15 minutes
- Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- Annual depression screening, 15 minutes
- High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semiannually, 30 minutes
- Annual, intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
- Face-to-face behavioral counseling for obesity, 15 minutes
Telemental Health Procedure Additions for 2015
Starting January 1, 2015, these additional procedures are approved for reimbursement:
- Family psychotherapy, with two separate codes, one for family therapy with the patient present and one for family therapy with the patient absent
- Prolonged evaluation, which will allow therapists to be compensated for sessions that go overtime.
- Chronic care patient management, which is not a telehealth code and does not require the patient to be present so it is available to be used for any medical patient, regardless of location.
- Psychological testing by computer, which also is not a telehealth code but is now reimbursable
With regard to psychological testing, the 2015 Medicare Physician Fee Schedule Final Rule (October 1, 2014), effective January 1, 2015 states:
CPT codes 96103 (psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report); and, 96120 (neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report). These services involve testing by computer, can be furnished remotely without the patient being present, and are payable in the CMS-1612-FC 194 same way as other physicians’ services. These remote services are not Medicare telehealth services as defined under the Act; therefore, we need not consider them for addition to the telehealth list, and the restrictions that apply to telehealth services do not apply to these services.
Types of Equipment Needed
Telehealth services have been reimbursed since 2001, in the CY 2002 PFS final rule with comment period (66 FR 55246) and includes consultations, office visits, office psychiatry services, and any additional service specified by the Secretary, when furnished via a telecommunications system. They generally require that a telehealth service be furnished via an interactive telecommunications system. Under §410.78(a)(3), an interactive telecommunications system is defined as multimedia communications equipment that includes, MS-1612-FC 187 at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. All interactive communication equipment must meet state and federal requirements for privacy and security. Skype then, is not an allowed interface without additional safeguards.
Past TMHI Updates
In the past, CPT codes were added for a wide range of behavioral procedures. See TMHI’s previous articles about CMS and CPT codes:
- Update on CMS Proposal for Telemental Health 2014 CPT Codes
- Centers for Medicare and Medicaid Services (CMS) Expands Telehealth Coverage
- New CPT Codes Approved for Telehealth
- Insurance Reimbursement: New List of All Telemental Health / Online Therapy Procedures Covered in 2013
- Medicare and Medicaid Proposed Rule to Cover Smoking Cessation
To learn more about specific procedure codes and processes for successful billing and reimbursement, see TMHI’s course: “Reimbursement Strategies: Increasing Authorization and Payment” which is part of the Advanced Certification Certification Program.