In Brief
The COVID-19 pandemic signaled a huge shift in the prevalence of telehealth therapy sessions, and those changes seem to be here to stay. Telehealth plays a significant role in mental health care by offering convenience and accessibility to both clients and therapists. As virtual therapy sessions gain popularity, mental health professionals need to stay updated on the latest developments in telehealth billing and coding practices.
Understanding Current Procedural Terminology (CPT) codes is an important part of telehealth billing, as these codes ensure proper reimbursement for services rendered. With the continuously changing landscape of telehealth regulations and guidelines, keeping up with the most current CPT codes is key to running a successful and compliant practice. Let’s explore CPT codes and their application in mental health telehealth services, covering the basics, their usage, recent updates, and the most commonly used codes in mental health telehealth for 2025.
What is a CPT Code?
CPT codes are five-digit numeric or alphanumeric codes that describe medical, surgical, and diagnostic services provided by healthcare professionals. The American Medical Association (AMA) develops and maintains these codes, using them to communicate uniform information about medical and mental health services to healthcare payers for reimbursement purposes. It is important to note that CPT codes are also used in various other contexts, such as diagnostic tests, surgical procedures, and even some administrative functions.
How are Mental Health Telehealth CPT Codes Used?
Mental health telehealth CPT codes help accurately bill for remote therapy sessions, ensuring proper reimbursement and compliance with regulatory guidelines. These codes have differences from in-person service codes in several key aspects:
- Place of Service (POS) Codes: Some insurance companies require the use of POS code 02 for telehealth services, while others might need the standard POS code 11 (office visits) along with a telehealth modifier.
- Modifiers: The most common telehealth modifier is "95," indicating that the service occurred remotely. For example, CPT code 99213 with the "95" modifier shows an evaluation and management service conducted via telehealth.
- Documentation Requirements: Telehealth documentation must include client identification and consent, the date and time of the visit, mode of communication (audio/video or audio-only),, client and provider locations, and other relevant clinical and treatment details.
- Service Descriptions: Many CPT codes are the same for mental health telehealth and in-person services (e.g., 90837 for psychotherapy for 60 minutes with a client, either individually or in a group) and rely on a POS code and modifier to indicate that the service was delivered via telehealth
- Billing and Reimbursement: Payment structures for telehealth services are generally similar to in-person services, but may vary depending on the specific service and payer policies.
Mental health professionals must keep up with the latest guidelines from the Centers for Medicare & Medicaid Services (CMS) and other regulatory bodies to ensure accurate coding and billing practices for telehealth services in 2025 and beyond.
CPT Code Updates for 2025
The year 2025 brings several notable changes to the CPT code set for mental health telehealth services. These updates reflect how remote care delivery continues to change and aim to provide more accurate coding options for virtual therapy sessions. Let's explore the key changes:
- New Audio-Video Telemedicine Codes: The CPT 2025 code set introduces new codes for audio-video telemedicine visits, with separate codes for new clients (98000-98003) and established clients (98004-98007). These codes better describe the nature of the virtual visit and replace the previous codes used for such services.
- Audio-Only Telemedicine Codes: New codes for audio-only telemedicine visits have been added, specifically for new clients (98008-98011) and established clients (98012-98015). These codes replace the existing telephone-only codes 99441-99443, which will be deleted from the CPT code set in 2025.
- Virtual Check-In Code: A new code, 98016, has been introduced for brief virtual check-in encounters, replacing the existing HCPCS code G2012. This code allows for more accurate billing of short virtual interactions between clients and providers.
- Remote Patient Monitoring (RPM) Updates: CPT codes related to RPM have been revised, with code 98975 now including digital therapeutic intervention and codes 98976-98978 revised to include device supply for data access or data transmissions to support RPM.
Mental health professionals need to stay informed about these updates and ensure their billing practices follow the latest guidelines. Proper documentation, including the modality of the visit, client consent, and specific services rendered, remains important for accurate coding and reimbursement.
While the new CPT codes provide more options for telehealth billing, it's important to note that some payers, such as CMS and certain private insurers, may not immediately reimburse for these new codes. Providers should communicate with payers about coverage and continue to use existing code and modifier combinations as required.
Most Commonly Used Mental Health Telehealth CPT Codes
As mental health professionals work with telehealth in 2025, knowledge of the most commonly used CPT codes is important for accurate billing and reimbursement. Here are 25 of the most frequently used mental health telehealth CPT codes:
- 98000-98003: New client audio-video telemedicine visits
- 98004-98007: Established client audio-video telemedicine visits
- 98008-98011: New client audio-only telemedicine visits
- 98012-98015: Established client audio-only telemedicine visits
- 98016: Brief virtual check-in encounter
- 90791: Psychiatric diagnostic evaluation without medical services
- 90832: 30-minute psychotherapy session
- 90834: 45-minute psychotherapy session
- 90837: 60-minute psychotherapy session
- 90846: Family or couples psychotherapy without the client present
- 90847: Family or couples psychotherapy with the client present
- 90849: Multiple-family group psychotherapy
- 90853: Group psychotherapy (other than a multiple-family group)
- 90839: Psychotherapy for crisis, first 60 minutes
- 90840: Add-on code for each additional 30 minutes of crisis psychotherapy
- +90833: 30-minute psychiatry E/M code (used with 90832)
- +90836: 45-minute psychiatry E/M code (used with 90834)
- +90838: 60-minute psychotherapy E/M code (used with 90837)
- 96101: Psychological testing by a psychologist
- 96130: Psychological testing evaluation services by a physician or other qualified healthcare professional
- 98975: Remote therapeutic monitoring, initial set-up and client education
- 98976: Remote therapeutic monitoring, device supply for data access or data transmissions
- 98977: Remote therapeutic monitoring, 20 minutes of treatment management services
- 98978: Remote therapeutic monitoring, each additional 20 minutes of treatment management services
- 98979: Remote therapeutic monitoring, treatment management services, interactive communication, first 20 minutes
It's important to follow the latest guidelines for time rounding, minimum time requirements, and service location when billing these codes. Proper documentation, including the type of visit, client consent, and specific services provided, remains important for accurate coding and reimbursement in 2025.
Frequently Asked Questions (FAQ)
Are there any special considerations when billing for mental health telehealth services?
- Modifiers: Apply the appropriate telehealth modifier (e.g., "95") to show the service occurred remotely. Some payers might need additional modifiers for specific services or situations.
- Place of Service (POS) Code: Use the correct POS code for telehealth services. As of 2025, POS code "02" applies to telehealth services, but it's important to check with individual payers for their specific requirements.
Can I bill the same CPT codes for telehealth services as I do for in-person services?
In most cases, you can. Many mental health CPT codes, such as 90791, 90832, 90834, and 90837, apply to both in-person and telehealth services. However, some codes are specific to telehealth, like the new audio-video and audio-only telemedicine codes introduced in 2025.
How do I document telehealth sessions for proper billing?
When documenting telehealth sessions, make sure to include:
- Date of service
- Mode of communication (e.g., audio-video or audio-only)
- Patient consent for telehealth services
- Patient and provider locations
- Start and stop times for timed services
- Specific services provided and any relevant clinical notes
Proper documentation is important for accurate billing and to support claims in case of audits.
Are there any mental health services that cannot be provided via telehealth?
Some services, like psychological testing (96130-96139) and certain types of group therapy, may have restrictions or limitations when delivered via telehealth. It's important to check with payers and stay updated on the latest guidelines and regulations regarding telehealth services.
Key Takeaways
As mental health professionals manage telehealth CPT codes in 2025, there are several important points to keep in mind:
- Stay updated on new and revised CPT codes: The year 2025 introduces new audio-video and audio-only telemedicine codes, as well as updates to existing codes for remote client monitoring and virtual check-ins. Get familiar with these changes to ensure accurate billing.
- Use appropriate modifiers and Place of Service (POS) codes: Apply the correct telehealth modifier (e.g., "95" to indicate telehealth services that are provided in real-time via an interactive audio and video communication) and POS code (e.g., "10" to indicate telehealth services that are provided in the clients home) when billing for telehealth services. Check payer-specific requirements, as they may vary.
- Document telehealth sessions thoroughly: Include client identification and consent, the date and time of the visit, mode of communication (audio/video or audio-only), client and provider locations, and other relevant clinical and treatment details. This supports accurate billing and protects against audits.
- Verify coverage with individual payers: Medicare and private payers may have different policies on covered telehealth services. Check with each payer's provider relations representatives for their specific guidelines and requirements.
- Obtain and document client consent: Confirm and document client consent for telehealth visits, especially for audio-only services. Discuss the benefits and limitations of these services with your clients.
- Follow time rounding and minimum time requirements: Adhere to the latest guidelines for time rounding and minimum time requirements when billing for timed services, such as psychotherapy sessions.
