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Several under-utilized telehealth CPT codes have been approved for telehealth professionals. However, at this point, it is uncertain whether their underutilization exists because clinicians don’t know they can be used or if they are being improperly coded.
One such telehealth CPT code is 96127. This CPT code is a generic mental health screening code that pays for emotional/behavioral assessment, including scoring and documentation, utilizing standardized instruments. For example, a digitized depression inventory is one such assessment. See this webpage 96127 CPT Code for other assessment tools.
Furthermore, any qualified healthcare professional can bill for this service. That is, the professional does not need to be a mental health professional. As of January 2021, the Centers for Medicare and Medicaid (CMS) has specifically approved this CPT code for telemedicine.
Using the Correct ICD-10 Code
Clinicians should use the ICD-10 code Z13. 89 when billing for telehealth CPT code 96127. Generally, it can be used up to four times a year with four units per visit. However, each insurance company establishes its own limits, so it’s best to check with the individual insurance payer for their rules.
What’s it Worth?
Medicare does not seem to have stipulated how many times telehealth CPT code 96127 can be billed. The Medicare reimbursement rate for this CPT code is $5, but the rate varies by the other carriers. It, therefore, is best to check with each payer. While these changes may seem small to some professionals, they can add up if used regularly and appropriately.
Know the Payer’s Requirements
Some insurance companies do not require prior authorization or medical records to support the need for some of these additional telehealth services because they are meant to be a generic screening tool applied to a large patient population to identify mental health issues. However, it’s best to check with the individual insurance companies about their requirements before billing for this service to be safe.
Other Billable Telehealth CPT Codes
CPT Code 99091
CPT code 99091 can be billed when using remote patient monitoring (RPM) with clients via telehealth. RPM refers to a range of technologies used to monitor clients’ behaviors or bodily processes outside of the clinician’s office. RPM has many potential benefits, including:
- improving convenience and access to healthcare for the client
- improving healthcare efficiency
- having clients take an active role in the own healthcare
- helping clinicians to detect problems earlier
What RPM Services Include
The service is paid for includes clinician time accessing, reviewing, and interpreting the data, modifying the care plan if needed, documentation, and communicating with the client and/or client caregiver. Medicare pays $58.67 per month for this service, and it can only be billed once per month. For more information on reimbursement for RPM, see Remote Patient Monitoring Telehealth Can Increase Revenues.
CPT Codes 90839/90840
CPT codes 90839 and 90840 can be used for psychotherapy provided in crisis sessions. While 90839 covers a 60-minute session, 90840 is used as an add-on code for each additional 30 minutes. Both codes need to be listed on the billing form.
CPT Code 90785
CPT code 90785 is another add-on code used for sessions with Interactive Complexity, i.e., there are complicating factors occurring during a session, such as communication difficulties. It is also an add-on code used with other primary CPT codes and is never used standalone.
CPT Code 96160 and 96161
CPT codes 96160 and 96161 may be used to bill for completion of health risk assessments, either for the client (96160) or the caregiver (96161). An example of a health risk assessment is questions concerning smoking, alcohol or other substance abuse, exercise, prevention testing such as mammograms, colonoscopies, etc.
Clinicians can maximize their billing potential by staying on top of the ongoing revised codes and billing rules that may allow them to be paid for work they are already doing. Telehealth.org also provides accurate and up-to-date telehealth professional training. Register now to How Can I Get Paid for Telehealth Services in 2021? and invite your colleagues too to keep up with telehealth reimbursement updates, telemedicine CPT codes, telehealth modifier codes, and often-neglected additional fees that can be collected for telehealth.
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.
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I have several denials for 96161 & 96127 are these paid by Illinois Medicaid ?
Jamie,
Thank you for your inquiry. Unfortunately, we cannot provide a direct answer for you but are fully aware of the difficulties involved with getting clear answers to these confusing questions. We have made your request public in the TBHI Telehealth.org in the hope that someone else in our community of readers can help you.
Meanwhile, you may want to contact the office that sent you the denial. Phone numbers and occasionally, email addresses are available in the rejection notice. (Some insurers intentionally play auditorially noxious music while they put us on hold for hours at a time – or never answer at all.)
Best of luck to you.
Marlene
will you cover which insurance companies are paying or not paying for telehealth sessions in 2021?
Ellen, Thank you for your inquiry. Because 3rd party carrier information is different from one profession to another within states, as well as different from one state to another, we cannot pretend to offer a 1-hour program to cover all insurers. Actually, if anyone sees such a resource, please be sure to post it here as I am sure than many members of our community would be quite interested.
However, we will discuss trends across insurers, Medicare and reasonable future prospects for telehealth opportunity growth. I hope this makes sense to you, and that you carefully review the topics that we will be covering, as they are quite extensive: https://blog.telehealth.org/telemedicine-cpt-codes/
This 1-hour program will brief you on:
Who can get paid for telehealth services?
What CPT codes are now available for 2021?
Which additional fees can be used for telehealth?
When will more legislative changes occur?
Where to go if you are not getting paid?
How to best think about your brick-and-mortar office?
How is coding different for behavioral telehealth service?
Are you required to use a HIPAA-compliant platform to get reimbursed during COVID?
Can you get reimbursed for delivering care to someone over state lines or international borders?
Are telehealth billing rates the same as in-person service delivery?
What are the specific billing codes for telehealth:
Telehealth Assessment?
Telephone?
Group therapy?
Family therapy?
Virtual Check-Ins?
Remote Evaluation
Remote patient monitoring (RPM)?
Telesupervision?
Telehealth Modifier codes?
Changes in the 2021 Physician Fee Schedule
Private carrier telehealth coverage rollbacks
Why is interjurisdictional practice an issue in telehealth reimbursement?
What’s the issue with insurance plans to waive co-pays? Why are you getting paid less?
Which 3rd party payers are rolling back telehealth benefits now?
Who are the best payers to consider when planning a telehealth focus for your practice?
What are the best Medicare and Medicaid opportunities now?
What is a facility fee and which telemedicine CPT code to you use to collect it?
Where to get up-do-information about telehealth reimbursement in different states so that you can grow a thriving telehealth service into the future?
Are out-of-network providers also being covered for telehealth services?
How can you correct a claim if you made errors?
Does your documentation need to be different for telehealth?
What do you if payers don’t pay for legitimate and correctly coded telehealth services?