COVID-19 Behavioral Health Telehealth & Professionals in Training Updates

Providers have been asking for clarification regarding what behavioral health services can be provided via telehealth. As previously published, telehealth services initiated or previously scheduled by the provider may be billed as long as the services provided meet all criteria of the CPT or HCPCS code listed on the CMS 1500 or UB04 form. Services that are eligible include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy (PT) plan evaluation
  • Occupational therapy (OT) plan evaluation
  • Speech therapy (ST) plan evaluation
  • Behavioral health and substance use disorder treatment
  • Diabetes education
  • Nutrition counseling

For services outside of E/M visits and telehealth/digital visits, providers should use the appropriate CPT or HCPCS code and include the modifier 95 on all services when completed in a face-to-face situation (example video chat). Providers should submit Place of Service 02 if the provider is rendering services via telehealth.

Commonly asked behavioral health questions outside of the therapy/office visits mentioned above:

Service or Program

Coverd via Telehealth

Submit claim on UB04

Submit claim on CMS 1500

Applied Behavioral Analysis (ABA)

Yes

N/A

• Use traditional ABA codes
• Modifier 95
• Place of Service (POS) 02

Partial Hospital Program (PHP): Psychiatric & Substance Abuse

Yes

Traditional PHP: (20+ hours per week): Services not provided by telehealth – Reimbursed Per Diem

Providing telehealth services that don’t meet all PHP program requirements: (i.e. group therapy or medication management or family therapy etc.) but doesn’t meet all the same program requirements as traditional PHP – Reimbursed based on billable services (by payable and credentialed providers such as LPCC, LAC, LCSW, Ph.D. etc.)

Telehealth PHP: (If this meets all the same program requirements that are provided during traditional PHP (20+ hours per week) – Reimbursed Per Diem

·     Must include the DR condition code to attest that these services were provided via telehealth during COVID-19

Intensive Outpatient (IOP): Psychiatric & Substance Abuse

Yes

Traditional IOP: (Services not provided by telehealth) – Reimbursed Per Diem

Providing telehealth services that don’t meet all the IOP program requirements: (i.e. group therapy or individual therapy etc.) but doesn’t meet all the same program requirements as traditional IOP – Reimbursed based on billable services (by payable and credentialed providers such as LPCC, LAC, LCSW, Ph.D. etc.)

Telehealth IOP: (If this meets all the same program requirements that are provided during traditional IOP) – Reimbursed Per Diem

·     Must include the DR condition code to attest that these services were provided via telehealth during COVID-19

Outpatient Group Therapy (i.e. Relapse Prevention, LIOP etc.)

Yes

N/A

• Use traditional outpatient group therapy codes
• Modifier 95
• Place of Service (POS) 02

Professionals in Training Updates: