Center for Medicare and Medicaid Services (CMS) Approves New Telemental Health CPT Codes

Telemental Health CPT Code Changes 2015

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:

  • Psychoanalysis
  • 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:

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.

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8 comments on “Center for Medicare and Medicaid Services (CMS) Approves New Telemental Health CPT Codes

  1. I guess everyone should know about CPT changes in 2015 as per the American Medical Association (AMA) which was already released in August 28, 2014. Around 500 plus codes are changing and it will be effective from 1st January 2015. Further to this, physicians and other healthcare professionals will need qualified & experienced coders to understand the changes and assign a proper coders for regular reimbursement.

    • Jim,

      These new CPT codes are not policies, but yes, there are new policies for telehealth being enacted in various states every month. Federal changes are also occurring rapidly in the US and internationally.

      Of the telehealth areas, telemental health is the most rapidly growing.

  2. I have called Medicare and I’m not confident they are providing the correct answers. I am on disability and just this past April, 2017 I was finally eligible to receive Medicare. I have been in long psychotherapy for several years and working with a psychologist. Currently, I am not living close to where I can go to her office regularly and I need to have 2-3 sessions with her per week. We have been having tele psychology sessions during the time I have not been residing near her office. Eventually, I will be living back in that area but for now, I’m reliant on tele psychology sessions. The Medicare.gov web site is not sufficiently detailed regarding this issue in my opinion. It looks like they are covered and indeed the representative said they were. My questions to the Medicare office was can these sessions be covered? If so, can you point me to the documentation that specifically states that along with the correct billing codes she should use? Secondly, can she bill for all the sessions that we have had going back to April since I first started using Medicare? Thank you.

    • Joe, Yes, there are billing and modifier codes for telehealth. To get details, come to our 1-hour webinar on February 6: Maximizing Telehealth Reimbursement: New Billing, Coding & Credentialing Strategies for 2019″ or for more detailed information and very specific handouts, see our three-hour online course: Telemental Health and Telebehavioral Health Reimbursement Strategies: Increasing Authorization & Payment. Individual consultation is also available if you want immediate answers.

    • Joe,

      Yes, there are specific billing codes for some types of treatment and assessment, as well as modifiers to add to current codes for telehealth reimbursement. Different settings/codes and professions also have a variety of restrictions. For more information, I’ll paste what I just told Marjorie in response to a similar question:

      You are wise to seek additional information. Several other factors need to be considered. You may want to attend the inexpensive webinar that we’ll have on this topic this coming Tuesday at 11 am Pacific. (It will be fully recorded in case you can’t attend the live event, too.) Maximizing Telehealth Reimbursement: New Billing, Coding & Credentialing Strategies for 2019. The information will thereafter be made available on-demand and posted on this page. A single CME or CE is available with this event as well. See details at the bottom of that webinar description page to get live CME or CE credit.

      If you’d like even more information, TBHI offers a 3-hour course that covers telehealth reimbursement issues from soup to nuts. See this page for details: Telemental Health and Telebehavioral Health Reimbursement Strategies: Increasing Authorization & Payment

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