With the growing demand for virtual therapy, understanding how to bill for telehealth services is crucial for mental health providers. Telehealth billing comes with unique nuances, particularly when it comes to insurance requirements and proper coding.
Key Considerations for Telehealth Billing:
- Place of Service Codes (POS):
For telehealth sessions, you’ll commonly use POS 02 (telehealth provided outside the home) or POS 10 (telehealth provided in the home). These codes inform insurance companies that the session was conducted virtually, and inform the insurance company of the location of the patient (not the therapist). - Modifiers:
Adding a telehealth modifier is often necessary. Use the GT modifier for real-time, interactive services, or 95 modifier for commercial insurance telehealth claims. These modifiers distinguish telehealth sessions from in-person visits.Most insurance companies require the 95 modifier, but some payers still require the GT modifier. - State Regulations and Insurance Requirements:
Coverage and billing guidelines vary by state and insurance provider, so it’s essential to verify telehealth policies with each payer. Many insurers have expanded telehealth coverage in response to the growing demand, but requirements still differ, especially regarding reimbursement rates. - HIPAA Compliance:
Ensure your telehealth platform is HIPAA-compliant, providing encrypted communication to protect patient information. Most insurance companies will only reimburse services delivered via secure, compliant platforms, and this is something that can be uncovered during an audit. - Reimbursement Rates:
While telehealth services are often reimbursed at the same rate as in-person services, this can vary. Some insurance companies have specific guidelines or reduced rates for virtual therapy sessions, so always confirm with the payer. - Documentation:
Telehealth services require the same detailed documentation as in-person services. It is especially important to ensure that you record the start and end times, service codes, and the method of telehealth (e.g., video, phone) for accurate billing. The start and end times of sessions are sometimes included by your EHR if you are using a system with a built in Telehealth option, but it is important to ensure that this is part of your clinical record if this is not automated.
Telehealth has become a permanent fixture in mental health care, but billing for these services requires attention to detail. Using the correct codes, modifiers, and platforms ensures smooth reimbursement and compliance with insurance and state regulations.
At Clear Path Billing Solutions, we make mental health billing simple and efficient. From timely claims submission to handling denials, we take care of the details so you can focus on your clients. Let us streamline your billing process and improve your cash flow. Book your free consultation today!
