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The new electronic version of the 2019 CPT codes manual is available from the Centers for Medicare and Medicaid Services (CMS). The Telebehavioral Health Institute has reviewed the manual to create this behavioral overview of revisions and additions that you’ll find relevant for telehealth reimbursement if you serve behavioral patients in 2019.
2019 CPT Codes for Telebehavioral Health
You’ll discover a new behavior assessment code intended to “address deficient adaptive behaviors (eg, impaired social, communication, or selfcare skills), maladaptive behaviors (eg, repetitive and stereotypic behaviors, behaviors that risk physical harm to the patient, others, and/or property), or other impaired functioning,” states the CPT book. The primary assessment code is:
- 97151 (Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian[s]/caregiver[s] administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan)
The code family also includes a supporting assessment code, 97152, which will be used to report the work of a provider working under the direction of a physician in a supporting capacity.
Also new are six 2019 CPT codes in the range of 97153-97158, which “describe services that address specific treatment targets and goals based on results of previous assessments,” according to CPT.
The medicine section also contains multiple new psychological testing codes in the range of 96130-96146, which are in the broader subsection of “central nervous system assessments/tests.”
Optimizing Telehealth Billing Current Telehealth CPT Codes Telehealth Reimbursement Strategies
Increase your telehealth revenue. Industry leaders explain how, when, and why to use telehealth CPT codes and modifiers.
I am a Licensed Clinical Social Worker in private practice – if psychotherapy sessions are to be done over the telephone is the POS 02 with no modifier vs POS 11 even though I am in the office – I am on all the major networks as well as being a Medicare Provider and Medicaid Provider through the managed health care plans – is the POS 02 to be used for all the networks – Thank you – Janet Gorfain, LCSW
Janet, POS was changed in early April and now it “11”.
One of our providers does testing using 96130/96131 and 96136/96137. Are these codes tele[mental] health billable? The provider records answers provided by patients for scoring. Is there a link or site that discusses telehealth testing and billing for psychologists? Can you please point us in the right direction.
Karen, Standard in-person codes apply for billing telehealth. Just add “95” in the modifier code box and use “02” in the Place of Service Code (POS). You can find more information about recent CMS code changes, along with several additional codes for telehealth beyond in-person codes here:
Only the CMS documents can be relied on, so I’d encourage you to rely on colleagues less, fact-check with CMS resources, speak with your thrid-party carriers directly if possible, and use your own judgment as best you can. Let us know how it goes.
I am looking for the telehealth CPT code to use for a new patient(Behavioral Health)in Dr’s office.
Janine, Use your same codes but put “95” as the modifier code and “11” for the POS code for Medicare. If you are billing a 3rd party carrier. you will need to ask them for their specific codes. while many follow Medicare coding, some do not.
When can you set up an origination fee? We have a doctor that moved to Texas and wants to do telehealth from his Texas home, he has his Missouri licence and sees patients in Missouri at our clinic. Can we bill for an origination fee for his office in his home in Texas and can he also bill telehealth? He is a psychologist.
Terri, As the facility, yes, you can charge the facility fee to medicare but you are the only party that can bill. He cannot bill anything but his regular CPT code for the session.
Does Medicare cover nutrition medial therapy? Would the code still be 97802 and 97803 with POS 2?
Medicare has many rules that pertain to telehealth. First, they define who can deliver services and get reimbursed. You have not identified your profession, but licensed dieticians are included — and counselors are not. The other thing that is required at the present time is that patients be in a Metropolitan Shortage Area (MSA). You can look that up online by zip code.
As for the specific nutritional counseling codes that you mentioned, they can only be used if you are properly licensed to offer nutritional counseling. Each service that you offer will be included in the definition of practice in your state law. All such definitions are available online, and easy to find if you look at your licensing board’s website. You can call your licensing board and ask them where to find it if your own searches are unsuccessful. If you are not properly licensed, I’d suggest that you be very careful in billing for services. Medicare insurance fraud is one of the most serious offenses possible in healthcare.
Another often misunderstood Medicare rule is that you must be in the US when delivering services to Medicare patients through telehealth. And yes, the POS “2” is appropriate for telehealth.
Hope this helps!
I am looking for a 90834 VSee code for online psychotherapy. Is there anything beyond 90834 for the CPT code that needs to be included in the bill?
Marjorie, 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
Also, VSEE is a video platform company. They don’t establish or deal with reimbursement codes. Rather, they provide an excellent video platform for many types of telehealth applications. In the United States, the Centers for Medicare and Medicaid Services (CMS) is the entity that establishes healthcare reimbursement codes for the entire country. Have a peek at their website for a ton of very boring and complex information. 🙂
It’s simple – Place of Service is 02 and add the GT modifier (90834GT)
Thomas, you are correct about the POS code. The GT modifier is no longer needed by many groups according to my sources.