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Understanding Telehealth Reimbursement Rates

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someone understanding telehealth reimbursement rates

Telehealth’s reach in behavioral health has advanced over the last decade as demand for digital services and the elimination of barriers to care have been prioritized by clients/patients, communities, and providers. This tool has changed how providers deliver therapy to their clients considerably and has changed our field forever. 

Telehealth refers to delivering and distributing services and information through telecommunication technology. Sounds a bit dry, doesn’t it? It’s not. Let’s dig in. This term encompasses therapy sessions or visits over the phone, video visits, and other forms of digital communications. 

It is not limited to the medical profession, unlike its partner term telemedicine. Telehealth can be used by non-clinical therapists who wish to provide virtual visits to their clients in order to eliminate barriers to services and increase accessibility. 

In the United States, approved technologies can include videoconferencing, the internet, store-and-forward imaging, streaming media, and landline/wireless communications. Some payers have restrictions on what telehealth technology they approve for use.

When it comes to reimbursement rates, providers need to pay close attention to how they bill for telehealth services.

How to Optimize Telehealth Reimbursement Rates:

The biggest challenge? Optimizing telehealth reimbursements rates in coding claims correctly for therapists and practices to get paid. Depending on the service you wish to bill for, different CPT codes must be used for specific services for your claim for reimbursement to be approved and your payment to be received from a client’s insurance provider. 

Common CPT Codes for Telehealth:

Some of the most common CPT codes for telehealth include: 

99202-99205 E/M New Patient Office Visits – varies based on time, data level, examination level, and decision making. 

+99417* Modifier 

99211-99215 E/M Established Patient Visits

90791 – Diagnostic Evaluation – Integrated biopsychosocial assessment including history, mental status, and recommendations. Non-medical providers.

90792– Diagnostic Evaluation – Integrated biopsychosocial assessment including history, mental status, and recommendations. Medical services provided. 

90832 – Psychotherapy for 30 Minutes

90834 – Psychotherapy for 45 Minutes

90837 – Psychotherapy for 55 Minutes or More

90853 – Group Psychotherapy

90839, 90840, 90785 – Crisis Intervention and Interactive Complexity

+ 90836 Add On – Individual Psychotherapy 

+ 90838 Add On – Individual Psychotherapy when performed with evaluation and management services 

90845 – Psychoanalysis

90846 – Family Psychotherapy w/o the patient present

90847 – Family Psychotherapy w/ the patient present. 

Overall Benefits of Telehealth:

Eliminate Barriers to Care

Access to mental health care has historically been stunted by lack of access to services due to various barriers to care. These barriers included: travel, transportation, time, and other unavoidable obstacles to care for some clients in need. Telehealth eliminates many of these barriers. For example, a client without a way to get to and from an office can simply use their laptop at home for a session with their therapist.

Offers Convenience 

Convenience is a huge factor in whether or not clients regularly engage in their mental health care. Telehealth offers a wealth of convenience for clients who need it by making it simpler and easier to visit with their provider. 

Broadens Geographical Reach 

Before telehealth, therapists were limited to seeing patients in their immediate graphical area. Telehealth makes it easy to visit clients outside of a normal driving radius. 

Improves Time Management 

With a virtual visit solution, patients are more likely to be on time to their appointments, less likely to cancel, and is ultimately better for a provider’s time management. It is much easier to switch between telehealth visits in just a few clicks and utilize every ounce of time in the best way possible. 

The Importance of a Quality Telehealth Solution: 

The solution your practice ultimately chooses to implement influences the client experience, provider workflow, and more. Providers must find a telehealth solution that makes it easy to see patients, offers them a quality experience, and streamlines their workflow. 

Providers should search for an experienced vendor of a virtual telehealth solution explicitly built for mental health providers. Telehealth technology is not going anywhere anytime soon. If anything, as time progresses, telehealth will grow in its overall popularity and use. Finding a quality solution is the first step in getting the most out of what virtual visits have to offer you and your clients. 



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