Does Medicare Cover Telemedicine For Behavioral Health?

What is a 59 modifier?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used..

What is the difference between telehealth and telemedicine?

Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.

What insurances cover telehealth?

The big insurance carriers (BCBS, Aetna, Cigna, United Healthcare) cover telemedicine. The largest commercial payers do cover telemedicine.

Is telemedicine covered by Medicare?

Medicare generally offers coverage for telemedicine services that are similar to regular interactions between health-care providers and patients. Such services include doctor visits, consultations, individual psychotherapy, and pharmacologic management. … Doctor’s or health provider’s office.

How do I bill Medicare to telemedicine?

Medicare requires you to use a GT modifier with the appropriate Evaluative & Management CPT code when billing telemedicine. If you bill telemedicine to a commercial insurance company you will use a regular E&M CPT code and a 95 modifier. Confirm that with the payer.

How do you get paid for telemedicine?

By default, telemedicine can always be billed directly to payments and collected via cash or credit. There are no regulations preventing the delivery of services over video. And in many states, video visits will satisfy the requirement of a face to face needed to write a prescription.

What is a 95 modifier?

95 modifier: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. … If your payers reject a telemedicine claim and the 95 modifier is not appropriate, ask about modifier GT.

What is the place of service code for telemedicine?

Database (updated October 2019)Place of Service Code(s)Place of Service Name02Telehealth03School04Homeless Shelter05Indian Health Service Free-standing Facility54 more rows•Feb 11, 2020

What CPT codes do you use for telemedicine?

For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

Is there a copay for telemedicine?

At the beginning of this pandemic, many insurance companies started waiving copays for telehealth visits to encourage people to stay home and to reduce stress on hospitals and health care facilities. And it worked: Telehealth visits rose more than 13% at their peak this summer.

What is a 95 modifier used for?

Modifier 95 is a fairly new modifier and used only when billing to private payers to indicate services were rendered via synchronous telecommunication. It is important to note that Medicare and Medicaid do not recognize modifier 95.

How do you bill for phone encounters?

CPT Phone Codes99441 phone call 5 to 10 minutes of medical discussion.99442 phone call 11 to 20 minutes of medical discussion.99443 phone call 21 to 30 minutes of medical discussion.

How do I conduct a telehealth visit?

Best Practices for the Virtual VisitChoose and be trained properly on the best technology for your specialty of care. … Ensure eye contact by adjusting the webcam to eye level. … Consider the exam room setting just as you would in the physical practice. … Improve visit efficiency by being on time.More items…•

What modifier do I use for telemedicine?

Physicians should append modifier -95 to the claim lines delivered via telehealth. Claims with POS 02 – Telehealth will be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.

How much does Medicare reimburse for telemedicine?

Medicare reimbursement for telemedicine at the same rate as a comparable in-person visit. Whether you’re billing a 99213 that was done in-person or via telemedicine, your billable rate should match the standard Medicare physician fee schedule ($72.81).