Billing for telehealth in American Indian and Alaska Native communities
Funding for Indian Health Service (IHS) programs is primarily provided through specific congressional appropriations. It is also supplemented by reimbursements from Medicare, Medicaid, and private insurance payers.
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Medicare billing guidance
The following common Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for services for telemedicine in American Indian and Alaska Native communities and include updates provided to the 2022 Medicare Physician Fee Schedule – PFS.
Coding guidance is subject to change. Please refer to the complete list of telehealth services covered by Medicare during the COVID-19 public health emergency from the Centers for Medicare & Medicaid Services.
Behavioral Health
Audio-only or video telehealth
Although Medicare reimburses for audio and video telehealth, audio-only reimbursement is currently covered only during the COVID-19 public health emergency.
| Category | Telehealth CPT codes and HCPCS codes |
|---|---|
|
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 |
|
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 counseling |
99406, 99407 |
|
Screening, brief intervention, and referral to treatment |
G0396, G0397 G0442, G0443, G0444, G0445, G0446, G0447 |
|
Opioid use disorder treatment |
G2086, G2087, G2088 |
Non-covered services
It is important to note that these behavioral health services are not Medicare reimbursable.
| Category | Telehealth CPT codes |
|---|---|
|
Developmental screening and testing |
96110 |
|
Health behavior intervention, family without patient |
96170, 96171 |
|
Psychophysiological therapy |
90875 |
Diabetes Management
| Category | Telehealth CPT codes and HCPCS codes |
|---|---|
|
Evaluation and monitoring outpatient follow-up |
99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215 |
|
Diabetes management |
G0108 |
|
Medical nutrition therapy |
97802, 97803 |
Uninsured or underinsured patients
According to 2019 Census data, the American Indian and Alaska Native population has the highest uninsured rate compared to other populations.
Providers can help provide high-quality care to these communities by offering free or low cost services, including:
- Free or low cost annual wellness visits
- Free or low cost well child visits
More resources
Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges (PDF) — from The Assistant Secretary for Planning and Evaluation, Office of Health Policy
Medicare for American Indians and Alaska Natives — from CMS
The Role of CMS in Indian Health Care (video) — from CMS