Hello Heather,
Thanks for your question about telepsychiatry and reimbursement. The answer can be complicated because it depends on which payer one is talking about. As you probably know, the codes may be the same or similar, but whether it's a covered service or not depends on who is paying for it (i.e., Medicare, Medicaid, or commercial).
Under Medicare, telehealth can be reimbursed if the originating site (where the client/beneficiary received the service) is in a rural Health Professional Shortage Area or a county outside of a Metropolitan Statistical Area. The distant site provider would use the Place of Service 02-Telehealth code to indicate the service took place via telehealth (and if it's asynchronous, use the modifier GT with the procedure code). Here's Medicare's guidance on this benefit and billing (for Original, fee-for-service Medicare), including the list of covered services (which includes psychotherapy, psychiatric diagnostic interviews, outpatient evaluation and management visits, and many more).
One important exception to the geographic limitations, though: because of the SUPPORT Act, effective July 1 of this year, Medicare removed the originating site geographic requirements and added the home of an individual as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder for services furnished on or after July 1, 2019.
Under Medicaid, it depends on whether the state Medicaid agency has it established as a covered service, and under what circumstances. They may, for instance, have place of service restrictions or only have it in place for certain services. I always recommend looking for confirmation directly from the payer source, e.g., the Medicaid program, the Managed Care Organization (or CCO, in Oregon's case) since coverage policies and billing guidelines can change frequently, but the Center for Connected Health Policy has developed a compendium of state telehealth laws and Medicaid program policies (this one last updated in spring 2019).
I hope that is helpful, and am happy to try to answer any others questions you or others have about this.
Nina Marshall
Assistant Vice President, Healthcare Finance
National Council for Behavioral Health
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Nina Marshall
National Council for Behavioral Health
Washington DC
(202) 684-7457 280
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Original Message:
Sent: 08-28-2019 17:36
From: Heather Jefferis
Subject: Telehealth for Psychiatry and Other BH Services
We are wondering if another provider in another state has been more successful and has a telehealth for psychiatry and other BH services; billing code or modifier and/or CMS approval that we could copy.
Thank you in advance for your help.
Heather Jefferis
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Heather Jefferis
Executive Director
Oregon Council for Behavioral Health
Portland, OR
971-804-4620
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