Guidelines for Telebehavioral Health Billing Prior Pandemic

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Guidelines for Telebehavioral Health Billing
Prior Pandemic
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Guidelines for Telebehavioral Health Billing
Prior Pandemic
Acceptance of Telebehavioral Health During
Pandemic COVID-19 was declared a global pandemic
in March 2020, resulting in social distancing
mandates and a rapid transition from in-person to
remote health care delivery formats. These same
mandates also pose significant threats to the
mental health and well-being of the public.
Similar to prior pandemics, long-term social
distancing and self-quarantining behaviors have
increased the incidence and severity of anxiety
and depression in the general public. As a
result, there has been an increased demand for
mental and behavioral health providers who use
telemedicine (i.e., telebehavioral health), an
invaluable solution to reach and serve the
behavioral health of the general population at a
distance. Telebehavioral health uptake has
traditionally been slow but steady, increasing
from 15 percent in 2010 to 29 percent in 2017.
Nearly 70 percent of psychologists have used
telemedicine since May 2020. Approximately 78
percent of psychologists, social workers, and
neuropsychologists have integrated telemental
health services into their practices since early
April 2020. Telebehavioral Health Billing Prior
Pandemic Despite evidence that suggest high
acceptance of telebehavioral services, low
insurance reimbursement or non-covered services,
hinder providers enthusiasm. During pandemic,
the Federal Communications Commissions COVID-19
Telehealth Program has been introduced to provide
connected care services to health care
professionals and their patients. Likewise,
different states have implemented reimbursement
laws in response to the pandemic and health
insurance companies have broadened coverage for
telebehavioral services. Lets understand these
telebehavioral health billing prior pandemic.
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Guidelines for Telebehavioral Health Billing
Prior Pandemic

• Medicare Telebehavioral Health Codes
• While private insurance providers have their own
  policies on how to handle telemedicine, most
  insurance payers are follow Medicare guidelines.
  Telehealth codes for Medicare reimbursement for
  telebehavioral health are as follows
• Aphasia and cognitive assessment 96105, 96125
• Behavioral screening 96127
• Diagnostic evaluation 90791, 90792
• Psychotherapy 90832, 90833, 90834, 90836, 90837,
  90838
• Psychoanalysis 90845
• Group psychotherapy 90853
• Family psychotherapy 90846, 90847
• Psychological and neurobehavioral testing or
  status exam 96116, 96121, 96130, 96131, 96132,
  96133, 96136, 96137, 96138, 96139
• Crisis intervention and interactive complexity
  90839, 90840, 90785
• Speech-language behavioral analysis 92524
• Psychological evaluation 96130, 96131
• Neuropsychological evaluation 96132, 96133
• Psychological neuropsychological test
  administration scoring 96136, 96137, 96138,
  96139

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Guidelines for Telebehavioral Health Billing
Prior Pandemic

• Health behavior assessment 96156, 96160, 96161
• Health behavior intervention, individual 96158,
  96159
• Health behavior intervention, group 96164, 96165
• Health behavior intervention, family with
  patient 96167, 96168
• Developmental screening and testing 96112, 96113
• Adaptive behavior assessment 97151, 97152, 0362T
• Adaptive behavior treatment 97153, 97154, 97155,
  97156, 97157, 97158, 0373T
• Therapeutic interventions 97129, 97130
• Therapeutic interventions (group) 97150
• Smoking and tobacco use counselling 99406, 99407
• Place of Service (POS)
• Place of Service (POS) is the box 24b on a
  standard CMS-1500 form.
• POS 02 Telemedicine provided other than in a
  patients home. The location where health
  services and health-related services are provided
  or received through telecommunication technology.
  Patients are not located in their home when
  receiving health services or health-related
  services through telecommunication technology
  (effective January 1, 2017) (description change
  effective January 1, 2022, and applicable for
  Medicare April 1, 2022). This is the preferred
  POS to use for private insurance to ensure
  reimbursement.

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Guidelines for Telebehavioral Health Billing
Prior Pandemic
POS 11 Office visit. This location is reported
if the location is somewhere other than a
hospital skilled nursing facility (SNF)
military treatment facility, community health
center state or local public health clinic or
intermediate care facility (ICF) where the health
professional consistently delivers health
examinations, diagnoses, and the treatment of
diseases or injuries on an ambulatory basis. This
POS was used early on during the PHE while
insurance payers were updating their systems to
accept POS 02 and related modifiers. Some
insurance payers are still requiring the use of
POS 11 instead of POS 02 if the proper modifier
shows that the session was a virtual visit. It is
important to check with your provider
representative if you have questions on what POS
to use. POS 10 Telemedicine provided in
patients home. The location where health
services and health-related services are provided
or received through telecommunication technology.
The patient is located in their home (which is a
location other than a hospital or other facility
where the patient receives care in a private
residence) when receiving health services or
health-related services through telecommunication
technology (this code is effective January 1,
2022, and available to Medicare April 1, 2022).
POS 10 is new, so insurance payers have not
updated their policies to include this POS.
Experience shows us that insurance payers will
warn you ahead of time via newsletters about when
they will begin implementing new POS for
telemedicine claims provided to a patient while
the patient is located at their residence. Until
then, it is best to continue to monitor this
possible upcoming change and prepare for it.
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Guidelines for Telebehavioral Health Billing
Prior Pandemic

• Telemedicine Modifiers
• For Audio Visual The modifier will need to
  land in Box 24d on a standard CMS-1500 form
• GT is the preferred modifier by most insurance
  payers.
• 95 is still used in some states as the preferred
  modifier. Check with the Provider Relations
  department to see what that insurance payer
  requires.
• Telemedicine Modifier Audio Only
• FQ modifier is being released for audio-only
  services as of 1/1/2022 however, because this
  modifier is so new, your insurance payer is
  likely not able to process a claim with this
  modifier. It will take time before this modifier
  is regularly reimbursed. This is yet another
  thing that needs to be brought up with a provider
  representative.
• Legion Health Care Solutions is a leading medical
  billing company providing complete billing and
  coding services to ensure accurate insurance
  reimbursement for your practice. To know more
  about our billing and coding services for
  telebehavioral health, contact us at 727-475-1834
  or email us at info_at_legionhealthcaresolutions.com

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