Video and Phone Sessions: Will Insurance Cover Them?
By Barbara Griswold, LMFT (Updated July 20, 2017)
Clients and psychotherapists alike are expressing increased interest in doing therapy by video or phone, also known as telehealth. While of course this makes therapy more accessible, “many therapists think they can just pick up the phone or jump on Skype and their sessions will be covered by insurance. Nothing could be further from the truth,” says Marlene Maheu, Ph.D., Executive Director of the Telebehavioral Health Institute.
The good news? There has been a steady shift toward laws that mandate insurance coverage of video sessions. Medicare and Medicaid have reimbursed for these services for over a decade in most states.
The bad news? Plans typically don’t reimburse for phone sessions, and in some states, they may reimburse video only in limited conditions. They may only reimburse when the client is in an underserved area, or there is no available provider nearby. Plans may not allow the client to be at home for the session. You also may need to be contracted with the plan, have done some telehealth training, or at least have attested that you know and will follow your state’s telehealth laws. Your client may need to have signed a special informed consent, and have done an in-person intake.
What is covered in my state? To check out “State Telehealth Laws and Reimbursement Policies April 2017,” which gives an overview then a state by state breakdown of telehealth laws, click here
How are video sessions billed? Use the same CPT code as you would have for in-person, but you’ll need to add a telehealth modifier after the CPT code (Box 24D on the CMS-1500 Form). For years plans have used the modifier GT, but there is a new 2017 telehealth modifier, 95, so you’ll have to contact the plan and ask which to use. Also, for the Place of Service code (Box 24B), put the number 02, which is the new code for a telehealth session of of January 1, 2017. Invoices/superbills should clearly state that it is a telehealth session and use the modifier. Remember: It is fraud to bill for a telehealth session in any way that would give the impression that it was a face-to-face session.
How are phone sessions billed? As I said, they usually will not be covered, so shouldn’t be billed to the insurance plan. The CPT codes that exist for phone consultations start with 99- , and designed for medical personnel for brief between-visit questions or updates.
How will I know if my services will be covered? Don’t assume — call your client’s insurance. “One Blue Cross client might have telehealth coverage and another Blue Cross client might not,” says Maheu. Ask whether you and your license are covered for the telehealth service you are providing, about coverage limitations (including client location), and which coding modifier to use.
What are rates like? Video sessions are usually reimbursed at the same rate as face-to-face sessions.
- Many experts suggest avoiding Skype, due to the lack of full HIPAA compliance. A list of some platforms that claim HIPAA-compliance (not just encryption) is at telehealth.org/video.
- You may need to be licensed in the state where the client is when you have contact. Ignoring this could cost you your license, and your malpractice may not cover you. Learn your state laws.
- Get training first to prepare for the different clinical, legal, ethical situations you may face, as well as technological and practical issues (ex. necessary forms and consents). The Telebehavioral Health Institute (telehealth.org) provides these trainings (sign up for their free e-newsletter here). Download “Practice Guidelines for Video-Based Online Mental Health Services” from the American Telemedicine Association — click here
- Your therapy is still subject to “medical necessity” treatment reviews by insurance plans (for more on medical necessity and treatment reviews, click here).
- If your client doesn’t have coverage for video or phone sessions, of course you can still do it. Draw up a Private Pay Agreement for the client to sign, stating they understand it is not covered, and will not be billed to insurance, and outlining the costs (a Sample Private Pay Agreement is in the back of my book). You should be able to charge up to your full private-pay fee for the service, since it is not a covered service.
For more help navigating the insurance maze, contact Barbara.