The COVID-19 pandemic brought about a significant increase in the need of CPT codes for mental health services in the United States. To ensure that providers can offer care through telehealth, the Centers for Medicare & Medicaid Services (CMS) and private insurance companies have expanded coverage for telehealth services. To aid with reimbursement for telehealth services, the American Medical Association (AMA) has created Current Procedural Terminology – CPT codes for mental health. In this article, we will discuss the CPT codes for mental health telehealth, the changes implemented during the Public Health Emergency (PHE), what the future holds for these codes, and what each code means.
What are CPT Codes for Mental Health?
CPT codes are numeric codes that describe medical procedures and services provided by healthcare providers. They are used to report services to insurance companies for reimbursement purposes. CPT codes for mental health are developed and maintained by the AMA and updated annually to reflect changes in medical practice.
CPT Codes for Mental Health Telehealth
The following are the CPT codes for mental health telehealth.
- 90791 – Psychiatric diagnostic evaluation. This cpt codes for mental health are used to bill for an initial evaluation with a mental health provider to diagnose and assess mental health conditions. This evaluation involves a complete history and mental status examination, including assessment of the patient’s social, emotional, and cognitive functioning.
- 90832 – Psychotherapy, 30 minutes with a patient. This code is used to bill for 30 minutes of psychotherapy with a patient in a telehealth setting. Psychotherapy treatment involves talking with a mental health provider to address emotional and mental health problems. This treatment can be individual or family therapy.
- 90833 – Psychotherapy, 30 minutes with a patient when performed with an evaluation and management service. This code is used to bill for 30 minutes of psychotherapy with a patient when it is performed in conjunction with an evaluation and management service for various cpt codes for mental health.
- 90834 – Psychotherapy, 45 minutes with a patient. This code is used to bill for 45 minutes of psychotherapy with a patient in a telehealth setting.
- 90836 – Psychotherapy, 45 minutes with a patient when performed with an evaluation and management service. This code is used to bill for 45 minutes of psychotherapy with a patient when it is performed in conjunction with an evaluation and management service.
- 90837 – Psychotherapy, 60 minutes with a patient. This code is used to bill for 60 minutes of psychotherapy with a patient in a telehealth setting.
- 90838 – Psychotherapy, 60 minutes with a patient when performed with an evaluation and management service. This code is used to bill for 60 minutes of psychotherapy with a patient when it is performed in conjunction with an evaluation and management service.
- 90853 – Group psychotherapy. This code is used to bill for group psychotherapy in a telehealth setting. Group psychotherapy involves treating multiple patients at once in a group setting.
- 96130 – Psychological testing evaluation services by a psychologist. This code is used to bill for psychological testing services provided by a psychologist in a telehealth setting. Psychological testing involves evaluating a patient’s cognitive, emotional, and behavioral functioning.
- 96131 – Psychological testing evaluation services by a technician. This code is used to bill for psychological testing services provided by a technician under the supervision of a psychologist in a telehealth setting.
Modifiers are codes used to describe a service or procedure that has been altered in some way, such as being performed in a different setting or using a different method. In medical billing, modifiers are used to indicate that a service was modified in some way, which can affect the payment received by the provider. Modifiers for mental health telehealth services are no exception for CPT codes for mental health.
The most commonly used modifiers for mental health telehealth services are GT, GQ, and 95.
- GT modifier: Used to indicate that a service was delivered through an interactive audio and video telecommunications system, such as videoconferencing, that allows for real-time communication between the patient and provider.
- GQ modifier: Used to indicate that a service was delivered via asynchronous telecommunications systems, such as store-and-forward telemedicine or remote patient monitoring.
- 95 modifier: Used to indicate that a service was delivered through a telehealth platform that meets certain requirements for reimbursement, such as using HIPAA-compliant technology and adhering to state and federal telehealth regulations.
Waivers and Privileges During the Public Health Emergency
The COVID-19 pandemic has caused a significant shift in the way healthcare services are delivered in the United States. When social distancing measures were in place, telehealth emerged as a vital tool for delivering care, especially for mental health services. The Public Health Emergency (PHE) declared by the government granted several waivers and privileges to mental health telehealth. How they have impacted mental health telehealth?
Waiver of Originating Site Requirement
One of the most significant waivers granted during the PHE is the waiver of the originating site requirement. This requirement mandates that patients must be physically present at a specific location to receive telehealth services. With the waiver in place, patients can now receive mental health telehealth services from their homes, which has increased access to care for those who cannot travel to a clinic.
Waiver of Audio-Visual Requirements
The waiver of audio-visual requirements has allowed mental health providers to use a range of communication technologies to provide telehealth services, including phone calls and messaging services. This has increased access to care for patients who may not have access to the necessary technology to participate in video conferencing.
Waiver of State Licensure Requirements
Another significant waiver granted during the PHE is the waiver of state licensure requirements. This waiver allows licensed mental health providers to provide telehealth services across state lines. This has increased access to care for patients who live in rural areas or those who may not have access to mental health services in their state.
Expansion of Medicare Telehealth Services
The Centers for Medicare and Medicaid Services (CMS) have expanded Medicare telehealth services during the PHE. This expansion includes adding mental health services to the list of reimbursable telehealth services. This has increased access to care for Medicare beneficiaries who may have limited access to mental health services in their area.
Waiver of Cost-Sharing for Telehealth Services
The PHE has also resulted in a waiver of cost-sharing for telehealth services for Medicare beneficiaries. This means that patients do not have to pay for telehealth services out of pocket, which has increased access to care for those who may have limited financial resources.
How Can you Boost Reimbursement for Mental Health Telehealth?
- Use Add-On Codes for Additional Services
As telehealth continues to rise in popularity for mental health services, it’s essential for providers to optimize their reimbursement strategies. While using the correct billing codes and documenting visits thoroughly are well-known tips, there are several other industry-specific recommendations that can help mental health providers maximize their telehealth reimbursement.
Providers can use add-on codes to bill for additional services during a telehealth visit, such as screening for cognitive impairment or assessing the patient’s risk of suicide. These codes are typically used in addition to the primary billing code and can provide an extra boost to reimbursement.
- Consider Group Therapy Sessions
Group therapy sessions can be an effective way to increase revenue while still providing high-quality care to patients. Providers can bill for each participant in the group session, increasing the number of billable services provided in a single session.
- Optimize Billing for CPT 99213
CPT 99213 is a commonly used billing code for telehealth visits that can lead to a lower reimbursement rate than other codes. Providers can optimize their billing for CPT 99213 by documenting the complexity of the visit and the time spent with the patient, which can increase the reimbursement rate.
- Use Modifier -95 for Private Payers
Modifier -95 is a specific billing modifier that can be used for private payers to indicate that a service was provided via telehealth. This can help providers receive higher reimbursement rates for telehealth services with private payers.
- Negotiate Rates with Payers
Finally, mental health providers can negotiate rates with payers to ensure that they are being reimbursed fairly for their telehealth services. This can be particularly useful for providers who have a large number of patients with a specific insurance plan and can lead to higher reimbursement rates and improved revenue.
Seeking higher reimbursements?
By understanding today’s CPT codes for mental health and integrating recommendations for mental health telehealth coding, providers can improve their telehealth reimbursement strategies and maximize their revenue. As a mental health provider, you can significantly increase your telehealth reimbursement rates by partnering with EMPClaims. Our team specializes in payer negotiation and can help you secure higher reimbursement rates for your telehealth services.
Want to optimize your revenue potential? Learn more about partnering with EMPClaims today.