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Billing for telebehavioral health

If you decide to provide telebehavioral health services, you will have to learn about rules and regulations for billing and reimbursement.

The federal government, state Medicaid programs, and private insurers have all expanded coverage for telehealth during the COVID-19 public health emergency. Most insurance companies cover telehealth services — often including behavioral telemedicine. To confirm coverage, make a habit of verifying each insurance provider policy. Ask patients to confirm their own coverage before each appointment.

Medicare billing guidance

Below are common codes used to bill for services, including some that were updated for the 2021 Physician Fee Schedule (PFS). Note: Although some services will be permanently reimbursable, this list also includes those that are temporarily covered, due to the COVID-19 public health emergency, and thus subject to change. See the complete list of telehealth services covered by Medicare during the public health emergency from the Centers for Medicare & Medicaid Services.

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.

Video telehealth only

Non-covered services

It is important to note that these behavioral health services are not Medicare reimbursable.

Medicaid

While each state is different, most have expanded coverage for telehealth due to COVID-19. Many are now matching Medicare’s telehealth coverage. Check your state’s current laws and reimbursement policies   to see what is covered. For updates on COVID-19 reimbursement and related Medicaid codes and procedures for your state, see:

• COVID-19 Related State Actions   — from the National Telehealth Policy Resource Center

Private insurance

Many code changes for COVID-19 care cover telehealth and include specific information for visits that are video- or audio-only. It is important to note that most states distinguish between reimbursement standards for permanent telehealth policies and temporary COVID-19 reimbursement policies. For tips on coding private insurance claims, see:

• Current State Laws & Reimbursement Policies   (Private Payer Laws) — from The Center for Connected Health Policy
• Coding Scenarios during COVID-19   — from the American Academy of Family Physicians

Tip: For help setting up billing and reimbursement for a new service, contact the National Telehealth Policy Resource Center  .

More details about billing and reimbursement:

• Behavioral Health Billing & Coding 101: How to Get Paid   (video) — from the American Medical Association (AMA)