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.
Category | Billing codes |
---|---|
Diagnostic evaluation |
90791, 90792 |
Psychotherapy |
90832, 90833, 90834, 90836, 90837, 90838 |
Psychoanalysis |
90845 |
Group psychotherapy |
90853 |
Family psychotherapy |
90846, 90847 |
Crisis intervention and interactive complexity |
90839, 90840, 90785 |
Speech-language behavioral analysis |
92524 |
Psychological and neurobehavioral testing or status exam |
96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 |
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 |
Behavioral screening |
96127 |
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 |
Video telehealth only
Category | Billing codes |
---|---|
Developmental screening and testing |
96110, 96112, 96113 |
Adaptive behavior assessment |
97151, 97152, 0362T |
Adaptive behavior treatment |
97153, 97154, 97155, 97156, 97157, 97158, 0373T |
Non-covered services
It is important to note that these behavioral health services are not Medicare reimbursable.
Category | Billing codes |
---|---|
Health behavior intervention, family without patient |
96170, 96171 |
Psychophysiological therapy |
90875 |
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)