As a result of changes that Congress made to the Social Security Act, last month Medicare expanded its coverage of telehealth services to include certain individual psychotherapy services. Under the legislative amendments, Medicare will now reimburse practitioners for specified services provided via telehealth to eligible beneficiaries under Current Procedural Terminology (CPT) codes 90804 through 90809 for insight-oriented, behavior-modifying or supportive psychotherapy in office or other outpatient facilities.
According to APA's Practice Directorate, the Social Security Act amendments significantly improve on earlier legislation, namely, the Balanced Budget Act of 1997, which governed how psychologists and others were reimbursed for providing telehealth services. The federal rules written to implement this legislation applied only to "evaluation and management" services, for which psychologists are not allowed to bill Medicare. By contrast, the new amendments direct Medicare to reimburse eligible providers for specified CPT codes for which psychologists may bill.
The Centers for Medicare and Medicaid Services (CMS) has proposed, in federal regulations, criteria for practitioners to qualify for payment for telehealth services to Medicare beneficiaries. According to CMS, services are reimbursable if clients receive telehealth services at "originating sites," which include physicians' and practitioners' offices, hospitals and rural health-care clinics. In general, these sites must be in a rural area that is designated as a health professional shortage area or a county that is not part of a metropolitan statistical area (a city with more than 50,000 inhabitants).
In addition, when providing telehealth services, practitioners must use an interactive telecommunications service, such as video teleconferencing. The multimedia communications equipment must, at a minimum, include audio and video equipment permitting two-way, real-time interactive communication between patient and practitioner. Telephones, fax machines and electronic mail systems do not meet the definition of an interactive telecommunications system.
Under the new rule, payment for telehealth services will be equal to the amount that Medicare would pay the practitioner for providing the service without the use of a telecommunications system. CMS states in the rule's preamble that because clinical psychologists may not seek payment for medical evaluation and management services delivered face-to-face, they also cannot bill for those services under telehealth.
For more information, e-mail David Nickelson, PsyD, JD, director of the Practice Directorate's Office of Technology Policy and Projects at OTP&P.