Historically, insurance companies have only reimbursed for telehealth when a patient presented at a physician’s office, medical clinic, hospital, community health center or skilled nursing facility. Care received at home was not reimbursable. Many professionals are also beginning to understand the benefits of working at home for Medicare and Medicaid as well.
There is no consistent pattern regarding which private payers are progressive about telemental health reimbursement, but depending on the state, the “Blues” have been leaders in this area. Currently, there is no clearinghouse for practitioners to access this information. However, the Telemental Health Institute has been part of a Special Interest Group of the American Telehealth Association which is compiling this information, and it should be available in the near future.
The good news is that there is growing consensus that telehealth makes a great deal of sense for provision of mental health services, and insurance companies are starting to recognize this. As we have previously reported in the TMHINews, Telehealth Reimbursement Advances, this recognition is fueled by state law in 16 states that mandate private payer telehealth coverage, with 15 states mandating that insurers cover telehealth at the same rate as services delivered in person. To date, Medicare coverage has been available in all 50 states, but that care has to be delivered to a patient who presents at an originating site, which is a physician’s office or other health care facility such as a psychologist’s office. Only certain designated practitioners are eligible for reimbursement for a limited number of clinical services delivered to beneficiaries, and only in rural areas. Under Medicaid, 39 states cover telehealth services but services and conditions differ across those states.
To date, these procedures are reimbursable for telemental health:
- Individual psychotherapy
- Individual psychiatric interview
- Individual and group health and behavior assessment and intervention
- Neurobehavioral status examination
- Pharmacologic management
- Smoking cessation
In final rulemaking for the 2013 Medicare Part B physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) have approved adding telehealth coverage for the following Healthcare Common Procedure Coding System (HCPCS) codes:
- G0396 and G0397 — 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.
- G0442 — Annual alcohol misuse screening, 15 minutes
- G0443 — Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- G0444 — Annual depression screening, 15 minutes
- G0445 — 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
- G0446 — Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
- G0447 — Face-to-face behavioral counseling for obesity, 15 minutes
The full 1362-page notice of proposed rulemaking is available here. An excerpt of the core 16 pages for telehealth is available here. The final rulemaking will be published in the Federal Register on November 16. Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are:
- Nurse practitioners (NP)
- Physician assistants (PA)
- Nurse midwives
- Clinical nurse specialists (CNS)
- 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); and
- Registered dietitians or nutrition professionals
As we have reported in our blog, States Requiring Private Insurance Payers Reimbursement for Telehealth, fifteen states mandate that insurers cover telehealth at the same rate as services delivered in person. Many private insurers are becoming increasingly willing to reimburse for telehealth services to the home.
Get your required training now, and consider the many benefits of staying home while you learn. Attend our Telehealth Summit where Rene Quashie, JD, a regulatory attorney from the Center for Telehealth & eHealth Law discusses pivotal reimbursement issues for an entire hour. His is only 1 of 11 audio recordings delivered to your desktop or any portable device, combined with 10 CEs or 8 CMEs. Transcripts and a CD are also available.
OR – join our Master Study Group (MSG) starting next Monday. MSG “Videoconferencing for the Pros” offers 6 CEs. All attendees get a free ticket to hear the Telehealth Summit 2012!