Billing for psychotherapy sessions via telehealth during COVID 19 crisis

Many questions have come up about how insurance companies want telehealth sessions billed.  Telehealth sessions are indicated with a modifier along side the regular psychotherapy CPT codes in box 24D of the CMS 1500 form.

All telehealth services are billed as place of service "02" in box 24B of the CMS 1500 form.  Medicare and Medicaid Connecticut do not require a modifier when billing telehealth services but you do have to bill with 02 place of service.  BUT Medicare will pay more if you bill it as POS 11 and 95 modifier.

The two modifiers you must use to indicate telehealth sessions were performed are:

GT: Via interactive audio and video telecommunication systems
95:  Synchronous telemedicine service rendered via a real-time interactive audio and video          telecommunications system

Below is a list of some popular companies and which modifier they prefer you use.

GT - Beacon, Quest, United, Aetna, BCBS NY, BCBS NJ, BCBS ILL, Highmark BCBS, Independence BCBS, Carefirst BCBS, GHI

95 - Cigna, BCBS TX, Healthfirst, Fidelis, BCBS VT.

These are just a handful of companies.  Feel free to reach out if you'd like additional information on more companies.

MVP no longer using Beacon Health Strategies

Beginning 1/1/2020, MVP will be managing it's behavioral health products in house and no longer using Beacon Health Strategies.  Call the number on the back on the MVP card to verify all outpatient mental health benefits and send all behavioral health claims directly to MVP

Optum/UBH fee increase

Many providers have been receiving letters from Optum/UBH network services indicating fee increases for many cpt codes.  If you have not received a letter by end of March 2019 contact Optum/UBH for a review of your contract fees.

Optum new 90837 policy

Effective 12/1/2018, Optum/UBH is no longer requiring preauthorization for the 60 minute therapy code 90837.

NY Empire BCBS fee schedule updates

Effective April 1, 2019 Empire BCBS will update it's HMO, EPO, PPO and Indemnity fee schedules.  

This link provides more detail:  https://providernews.empireblue.com/article/attention-updated-or-new-fee-schedules-for-commercial-products-revised-date

Optum telemental health services

Optum will be aligning with CMS guidelines which state:  place of service code 02 certifies that the virtual visit meets the telemental health service requirements.

Beginning with date of service January 1, 2019, Optum will reimburse for telemental health services with the use of place of service 02 along with the required GT modifier. 

Beacon Health and MagnaCare OSCAR providers

Oscar insurance and it's affiliates have decided to contract with Optum to manage the behavioral health benefits under their EPO health plans in New York and Texas.  This change takes effect January 1, 2017.

Providers currently in the Beacon Health Options or MagnaCare networks will be receiving letters informing them of this change and their termination with Oscar effective December 31, 2016.

If you are a provider who participates with Beacon Health Options or MagnaCare AND Optum, your Oscar patients should be unaffected by this change.  You will begin sending claims with dates of service January 1, 2017 and after directly to Optum.  Providers who participate with Beacon Health Options or MagnaCare but DO NOT participate with Optum will have to contact Optum Network Management to become credentialed.  Call 877-614-0484 or email bnsproviderupdates@optum.com.

Oscar will be offering patients in treatment with non participating Optum providers (90) days of continuity of care beginning January 1, 2017.  Claims will be paid as IN network for that time period. Any further questions about the Oscar provider network changes can be answered by calling 855-OSCAR-55.