Conditions for billing and payment for telehealth services:
To be reimbursed for telehealth services, the service must be on the approved list.
To view the approved list of telehealth services click here and select the most recent regulation number and then click on the following item “CY 2018 List of Medicare Telehealth Services”.
Also, all of the following requirements must be met (taken directly from the final rule):
● The service must be furnished via an interactive telecommunications system.
(audio and video equipment permitting two-way, real-time interactive
● The service must be furnished by a physician or other authorized practitioner.
(At this time Counselors and Marriage and Family Therapists are working to be added as authorized practitioners)
● The service must be furnished to an eligible telehealth individual.
● The individual receiving the service must be located in a telehealth originating site.
(The originating site is the location of the client and the distant site is the location of the clinician. Approved originating sites are those located in rural health professional shortage areas (HPSAs) or in a county that is not included in a metropolitan statistical area (MSA).)
Claims are to be submitted to the Medicare Administrative Contractors (MACs) that process claims for the service area where their distant site is located.
“Section 1834(m)(2)(A) of the Act requires that a practitioner who furnishes a telehealth service to an eligible telehealth individual be paid an amount equal to the amount that the practitioner would have been paid if the service had been furnished without the use of a telecommunications system.”
No more GT modifier. Now that the place of service 02 is used to designate telehealth the GT modifier is not needed (with the exception CAH Method II billing).
TeleMental Health Codes include:
90785 Psytx complex interactive
90791 Psych diagnostic evaluation
90792 Psych diag eval w/med srvcs
90832 Psytx pt&/family 30 minutes
90833 Psytx pt&/fam w/e&m 30 min
90834 Psytx pt&/family 45 minutes
90836 Psytx pt&/fam w/e&m 45 min
90837 Psytx pt&/family 60 minutes
90838 Psytx pt&/fam w/e&m 60 min
90846 Family psytx w/o patient
90847 Family psytx w/patient
Two new codes:
90839 Psytx crisis initial 60 min
90840 Psytx crisis ea addl 30 min