Insurance Coverage for Teletherapy
It’s evident that teletherapy offers numerous benefits for both counselor and client, some aspects of this service, such as insurance coverage, remain blurry. If you accept insurance, you’re probably wondering if you’ll get reimbursed for online therapy. In this blog, we’ll answer some of your questions about insurance coverage for teletherapy, so that you can determine if teletherapy is right for you.
The guidelines for insurance coverage for telehealth vary from state to state. You also need to consider the type of insurance plans your clients have. In general, the following factors will determine insurance coverage for teletherapy.
Method for Teletherapy
The method you use to deliver teletherapy might impact reimbursement, depending on your state’s laws. For example, even if your state’s Medicaid covers live telehealth sessions, you may not get reimbursed for store-and-forward sessions. A store-and-forward telehealth session is where the patient provides essential data for the clinician to analyze and diagnose electronically, but they do not interact directly. These might involve a client sending a document or pre-recorded video through email.
Some states only reimburse clinicians for therapy delivered via live video conferencing and will not provide reimbursement for telephone conversations, text messages or emails. If your state does reimburse for teletherapy delivered over the phone, it may only cover certain services. For instance, South Carolina’s Medicaid pays for telephone-delivered telehealth for dental services only. Alabama and Alaska clearly state their Medicaid programs do not cover telephone services. In general, you’ll always want to check your state’s laws to see what types of telehealth services are covered.
Place of Service
Where are your clients located when they receive teletherapy? Do they participate in virtual visits from their homes, or are they in school or a hospital? In 27 states, a home is an eligible place for patients to receive telehealth treatment under certain circumstances. Some states also allow schools to be the site of service delivery. Other states, like Iowa, do not consider a client’s home an eligible originating site. Instead, under Iowa’s Medicaid policy, you can get reimbursed for teletherapy if it’s delivered to clients in an office setting, hospital or community mental health center. These sites are paid a facility fee.
The Provider Type
You’ll want to consider if your state reimburses behavioral health professionals for teletherapy. Some states are highly selective regarding eligible health care providers, while others provide an extensive list of clinicians. For example, Virginia lists 16 eligible provider types, including psychiatrists, clinical psychologists, professional counselors and clinical social workers. Many states do not have details about provider type. If your state does not list eligible providers, you may want to contact your state’s Medicaid agency directly.
CPT Codes and Modifiers
Another type of restriction involves current procedural terminology (CPT) codes. Some states have specific guidelines regarding CPT codes. For example, Hawaii Medicaid specifies that clinicians must submit the GT, GQ or 95 modifier with the CPT code. The 95 and GT modifiers describe real-time interaction between a clinician and patient via a telecommunications system. The GQ modifier is used for asynchronous telehealth. To ensure your claims get accepted, review your state’s CPT code requirements for teletherapy.
Although most private health insurance companies offer some telehealth coverage, each plan varies greatly. Also, insurance policies change all the time, which makes matters more challenging. Figuring out whether you’ll get reimbursed by a particular insurance payer can get confusing quickly. To confirm you’ll get reimbursed, it’s always best to contact a client’s insurance provider. Find out if they cover teletherapy and how much you’ll get reimbursed. Make sure you understand which specific services a client’s plan covers. Some of the key points are as follows:
- Private insurance coverage for teletherapy varies by state and the insurance plan.
- Medicaid teletherapy coverage also varies by state, but currently, many Medicaid plans cover telehealth services.
- Medicare has expanded its teletherapy services and waived many of its restrictions due to the COVID-19 crisis.
Medicare will pay for brief virtual ‘check-ins’ to prevent unnecessary trips to the doctor. Doctors and some practitioners can respond to patients during a virtual check-in through secure text messaging, email, video platform, a patient portal or over the phone, but a few rules apply. For example, patients can’t use a virtual check-in if they have a medical visit within 24 hours. The American Medical Association provides a helpful list of resources to help you navigate recent Medicare changes regarding telehealth.
CMS wants states to expand telehealth services to accommodate patients during the COVID-19 crisis and help slow the coronavirus spread. That’s why they have lifted some restrictions to make it easier for providers to offer telehealth to clients and still get paid. Under 1135 waiver, Medicare covers telehealth for clients who live anywhere not just in rural areas. It also allows telehealth to take place in a beneficiary’s home. A range of providers, including clinical psychologists and licensed clinical social workers, will be able to provide teletherapy under this waiver. States get to determine whether to cover teletherapy services or not, as mentioned above. They also get to choose which services to cover, which types of providers can get reimbursed and how much to reimburse them. You’ll have to check your state’s Medicaid fee-for-service program to confirm coverage.
In many cases, teletherapy gets reimbursed at the same rate as in-person sessions, but this depends on a client’s insurance plan and whether your state has telehealth parity laws. Some states require private payers to reimburse eligible providers the same amount as an in-person session, while others let the payer decide. However, in response to the COVID-19 crisis, many insurance companies are implementing emergency plans to help beneficiaries pay for telehealth services.
To determine if a private insurance company will reimburse you, the smartest thing to do is contact the insurer directly. Check and verify coverage and note any limitations in the plan. Even when the same company covers two patients, one might have telehealth coverage, and the other might not. Find out if there are any extra steps you need to take to provide covered telehealth under the plan. You may have to be pre-authorized or be on the insurer’s telehealth provider list. Some companies may require some form of proof that you have comprehensive knowledge of the state’s telehealth laws.