Using Telehealth CPT Codes To Ensure You Are Getting Fully Compensated

Several under-utilized telehealth CPT codes have been approved for telehealth professionals. At this point it is uncertain whether their underutilization exists because clinicians simply don’t know they can be used, or if they are being improperly coded. 

One such telehealth CPT code is 96127. This CPT code is a generic mental health screening code that pays for emotional/behavioral assessment, including scoring and documentation, utilizing standardized instruments. A digitized depression inventory is one such assessment. See this webpage 96127 CPT Code for other assessment tools. 

Furthermore, any qualified healthcare professional can bill for this service. That is, the professional does not need to be a mental health professional. As of January 2021, the Centers for Medicare and Medicaid (CMS) has specifically approved this CPT code for telemedicine.

Using the Correct ICD-10 Code

Clinicians should use the ICD-10 code Z13. 89 when billing for telehealth CPT code 96127. Generally, it can be used up to four times a year with four units per visit. However, each insurance company establishes its own limits, so it’s best to check with the individual insurance payer for their rules.

What’s it Worth?

Medicare does not seem to have stipulated how many times telehealth CPT code 96127 can be billed. The Medicare reimbursement rate for this CPT code is $5, but the rate varies by the other carriers. It, therefore, is best to check with each payer. While these charges may seem small to some professionals, if used regularly and appropriately, they can add up.

Know the Payer’s Requirements

Some insurance companies do not require prior authorization or medical records to support the need for some of these additional telehealth services because they are meant to be a generic screening tool applied to a large patient population to identify mental health issues. However, it’s best to check with the individual insurance companies about their requirements before billing for this service to be safe.

Other Billable Telehealth CPT Codes

CPT Code 99091

CPT code 99091 can be billed when using remote patient monitoring (RPM) with clients via telehealth. RPM refers to a range of technologies used to monitor clients’ behaviors or bodily processes outside of the clinician’s office. RPM has many potential benefits, including:

• improving convenience and access to healthcare for the client
• improving healthcare efficiency
• having clients take an active role in the own healthcare
• helping clinicians to detect problems earlier.

What RPM Services Include

The service is paid for includes clinician time accessing, reviewing, and interpreting the data, modifying the care plan if needed, documentation, and communicating with the client and/or client caregiver. Medicare pays $58.67 per month for this service, and it can only be billed once per month. For more information on reimbursement for RPM, see Remote Patient Monitoring Telehealth Can Increases Revenues.

CPT Codes 90839/ 90840

CPT codes 90839 and 90840 can be used for psychotherapy provided in crisis sessions. While 90839 covers a 60-minute session, 90840 is used as an add-on code for each additional 30 minutes. Both codes need to be listed on the billing form.

CPT code 90785

CPT code 90785 is another add-on code used for sessions with Interactive Complexity, i.e., there are complicating factors occurring during a session, such as communication difficulties. It is also an add-on code used with other primary CPT codes and is never used stand alone.

CPT Code 96160 and 96161

CPT codes 96160 and 96161 may be used to bill for completion of health risk assessments, either for the client (96160) or the caregiver (96161). An example of a health risk assessment is questions concerning smoking, alcohol or other substance abuse, exercise, prevention testing such as mammograms, colonoscopies, etc.

Clinicians can maximize their billing potential by staying on top of the ongoing revised codes and billing rules that may allow them to be paid for work they are already doing. TBHI also provides accurate and up-to-date telehealth professional training. Register now to How Can I Get Paid for Telehealth Services in 2021? and invite your colleagues too to keep up with telehealth reimbursement updates, telemedicine CPT codes, telehealth modifier codes, and often-neglected additional fees that can be collected for telehealth.