6 Insurance Questions to Ask Before Billing for Telehealth (Updated)

Updated March 2020

You’ve probably heard about all the exciting possibilities of telehealth by now: It’s is a promising new method of delivering therapy, allowing you to expand your geographic reach and make it easier for clients to reach you more easily!

But we’re not talking about exciting possibilities today. Because with new methods come new complications. Aside from the clinical considerations you need to examine before doing any telehealth, navigating insurance company and plan benefits for telehealth can be extremely difficult.

Read on to learn six important questions to ask before you try to bill a telehealth session, because one payer may have a completely different answer than another.

1. Does Medicare/Medicaid reimburse for telehealth? What about private insurance companies?

Good news! Medicare and Medicaid (CMS) do reimburse for telehealth sessions – at the same rate as if you’d performed the session face-to-face.

With private insurance companies, the answer isn’t quite as simple. In at least 26 states, insurance companies are required to reimburse for telehealth in some form – though which clinicians and services are required varies. In the rest of the country, insurance companies are not required to reimburse for telehealth. But they may choose to do so anyways.

2. What kind of digital platform/equipment is required?

For the most part, this standard is actually fairly consistent. First and foremost, telehealth must be conducted using a digital platform that is HIPAA-compliant. That means telehealth can’t be conducted over Skype or Facebook Live.

Another common requirement is that you must use, “an interactive audio and video telecommunications system that permits real-time communication between you, at the distant site, and the beneficiary, at the originating site.” In other words, you must be able to interact with the client in real time using audio and video.

In limited cases, pre-recorded health data can be reviewed remotely and still be considered telehealth. However, this is usually not applicable in a therapeutic setting.

3. How do I code a telehealth session?

There are multiple methods for coding a telehealth session. For instance, the latest method from CMS (followed by some insurance companies) has you use the typical CPT code for your service (such as 90837) combined with place of service (POS) code 2, indicating the session was done via telehealth.

Other insurance companies require you to use the “GT” modifier (i.e. 90837:GT for a one hour teletherapy session), while still others require you to add modifier “95”, which is a different way of indicating the session was performed via telehealth.

And speaking of the client’s location…

4. Does the location of my client matter?

Where the client is located is called the “Originating Site.” Each payer can have slightly different rules regarding where the client must be located when they have their session as well as different security and compliance requirements for those locations. Some payers restrict telehealth services to locations in a Health Professional Shortage Area (HPSA) (link to HPSA list).

5. Does my client need to consent to using telehealth instead of face-to-face treatment?

The American Psychological Association recommends that, in addition to your typical informed consent, you receive written consent for participating in telehealth from your client before proceeding with treatment. While the state you live in may not require this, the client’s state or payer may require this additional consent to be collected.

6. Do I need to have an established clinical history with the client before using telehealth?

Not all insurance companies allow you to start your clinician relationship with a client via telehealth. Some, like HealthPartners, may require the client have an established relationship with you before telehealth can be conducted.

What else do you need to look out for?

Telehealth policies vary from payer to payer and even plan to plan. We highly recommend calling each client’s insurance plan before doing any telehealth sessions with them.

This is not by any means an exhaustive list of billing questions related to telehealth. The requirements of governments and payers are changing all the time when it comes to telehealth.

In your experience, what other billing questions should clinicians investigate before billing for telehealth? Post your questions to our Facebook page, tweet at us, or connect with us on LinkedIn.

Is this all just too complicated? Dealing with these questions takes up a lot of time – time you could spend hiring new therapists or marketing your practice to new clients. Sign up for BreezyBilling, our revenue cycle management services for therapists, and our billing experts will get to work right away for a fair price.