Clarification: Telephone sessions as part of telemedicine for behavioral health providers

Some of our participating psychologists and other psychotherapy practitioners have asked whether they can bill Blue Cross Blue Shield of Michigan for audio-only encounters. We want to let you know that an audio-only encounter is payable. Blue Cross medical policy does not require a visual component to telemedicine provided by psychotherapy practitioners.

These encounters are payable if they comply with CPT rules and Blue Cross medical policy. Psychologists and other psychotherapy practitioners may use the CPT codes that are within their scope of practice once the service has been delivered and they’re able to satisfy the documentation requirements of those codes.

Keep in mind that sessions involving a Blue Cross member must:

• Be synchronous — conducted in real time
• Utilize procedures that are within your scope of practice
• Meet documentation requirements for procedure codes reported

When submitting a claim for a telemedicine session, report the appropriate procedure code and place-of-service code 02. Code 02 identifies the service as telemedicine. You should also use modifier 95 or GT to indicate a real-time audiovisual encounter. (Modifiers 95 and GT should not be used for audio-only telemedicine encounters.)

The following codes don’t require a modifier as they’re specific to a telephone (audio only) evaluation and management or assessment and management service: *99441, *99442, *99443, *98966, *98967 and *98968.

• Codes *99441, *99442 and *99443 are used by M.D.s, D.O.s, nurse practitioners and physician assistants who deliver evaluation and management services.
• Codes *98966, *98967 and *98968 are used by qualified non-physician health care professionals, including psychologists and clinical social workers and other psychotherapy practitioners who deliver assessment and management services.

These codes have specific inclusions and exclusions in their nomenclature so be sure to check your CPT code book for details.

Notes:

• Even though this article is targeted to behavioral health specialists, the information is applicable to all providers within their scope of practice.
• Blue Care Network doesn’t reimburse health care providers for telephone-only sessions.

For more details, see the Blue Cross telemedicine policy and the BCN telemedicine policy.