Medicare Telehealth Program To Reimburse for Psychotherapy

Some psychiatrists who use telecommunication systems to provide individual psychotherapy or medication management will soon be eligible for Medicare reimbursement for these services, thanks to an expansion of the health plan’s telehealth project.

The federal agency that administers the Medicare program, the Health Care Financing Administration (HCFA), is expanding its telehealth service program effective October 1 to add coverage for psychotherapy and medication management, as well as for consultations in certain regions of the country.

Psychotherapy codes covered by the program are CPT codes 90804 through 90809; the applicable medication management code is 90862.

In addition to adding individual psychotherapy and medication management to the services eligible for reimbursement under the Medicare telehealth program, HCFA is expanding the program geographically. Only physicians practicing in rural areas that the government has designated “health professional shortage areas” have been included in the telehealth project. As of October 1, however, the eligible regions will include all counties throughout the country that are not included in a metropolitan statistical area.

Physicians and other health professionals who want to be eligible for the expanded Medicare program must have an “interactive telecommunications system” in place, according to the HCFA memorandum announcing the expansion. The agency notes that for a clinician or facility to be eligible for reimbursement, “interactive audio and video telecommunications must be used, permitting real-time communication between the distant site physician or practitioner and the Medicare beneficiary. As a condition of payment, the patient must be present and participating in the telehealth visit.”

Programs in Alaska and Hawaii will be allowed to use “asynchronous store and forward” telecommunications equipment, which allows the medical data to be transmitted and reviewed at a later date by the clinician at the distant site, according to HCFA. This does not, however, open the door to the inclusion of telephone calls, fax transmissions, and electronic mail “without visualization of the patient.”

Medicare telehealth services will be reimbursed at the same fee-schedule rate Medicare pays for face-to-face services, and the service must be within a practitioner’s scope of practice according to applicable state laws. Clinicians are to use the appropriate CPT code for the service they provide but add a “GT” suffix, which designates it as an eligible telecommunication service.

HCFA is also requiring Medicare insurance carriers to publish information about the telehealth changes in their next regularly scheduled bulletin and on their Web sites. They must also have the appropriate “edits” installed in their claims processing systems by the October 1 expansion date.

Additional details about the telehealth expansion under Medicare can be read on HCFA’s Web site at www.hcfa.gov/pubforms/transmit/ab0169.pdf. ▪