Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller

Do you worry that you only have a tentative handle on the telehealth billing guidelines? You aren’t alone.

All of the changes in billing practices throughout the pandemic have not made it easy to pin things down. Yet, even as billing for telehealth feels somewhat fluid, you can still capitalize on points of clarity that will allow you to bill appropriately and get paid promptly.

Key Things to Know When Billing for Telehealth

There is no shame in not knowing what you don’t know. To get anywhere in billing, you’ll need to be clear about which information gaps exist for you. Undoubtedly, you have questions:

• How do I bill telehealth the right way?
• What billing codes should I use?
• How can I expect reimbursement?
• Where can I find support?

The idea now is to get informed and get help when and where you need it. Here are several crucial topics to grasp when billing for telehealth:

Verify First: be sure that your client’s insurance covers telehealth

The most reliable way to secure payment for telehealth? Verify coverage with the client’s insurance  prior to your initial telehealth session. Specifically, call and ask if telehealth is a covered service. 

When you reach out, document the payer representative’s responses clearly. Include the call reference number, in case you need to dispute a denied claim later.

Just Ask: request the telehealth guidelines for each payer

How to know for sure what each payer wants for telehealth? Call and ask the proper questions! Talk to people who know. The following questions are a good start:

• What services can be fulfilled via telehealth?
• Are live video telehealth sessions covered?
• What restrictions exist or conditions must be met to ensure a client qualifies for telehealth?
• Do you require a third party platform for telehealth, like teladoc, livehealth or mdlive? 

It’s important to realize that  guidelines vary depending on the payer, your state, etc. Talking to the payer directly is very helpful. Getting guidance from people who work with that payer is invaluable as well.

Be aware that telehealth is evolving due to our changing times. So be patient and persistent. Even if your telehealth claims are rejected at first, don’t give up. Do your research and try again.

Stay Current: keep a list of telehealth-eligible CPT codes from each payer

CPT billing codes are key. The simplest way to know which codes are eligible or each payer is to request them periodically. If they say they can’t provide them? Ask about specific codes (see my blog post about CPT codes)  CPT codes with a modifier (learn more below).

Know your Modifiers:  understand when to use GT and 95

Are you billing telehealth to a commercial insurance company? No problem, use a regular CPT code and a 95 modifier on the HCFA 1500 form to indicate telehealth. Also, do verify that with the payer when you’re first starting the process.

Are you billing telehealth to Medicare? The 95 modifier informs your Medicare payer that you provided medical service via telehealth. 

The GT modifier is being requested less and less these days and is use to be the standard. Now, most insurance companies want you to use 95 instead, which is defined as synchronous Telehealth.

Location matters: bill the correct place of service code 

When billing telehealth services, on the HCFA 1500 form, healthcare providers must bill the E&M CPT location code of 02 instead of 11 along with the modifier GT or 95. If you do not use the 02 code, the telehealth services  will not be accepted by the payer. This is the case for both Medicare and other insurance providers.

You Have Telehealth Billing Support Available

Hopefully, you understand enough of the key areas to get going! If you have more telehealth billing questions, that’s perfectly okay! I run a Facebook group for insurance billing for Telehealth to help you in real time. Link here: http://bit.ly/2kKfZXp  and please join us soon. Let’s talk things through together with others looking to master telehealth billing too.