Psychotherapy via webcam


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A client is choosing to offer psychotherapy via webcam and/or telephone and wants us, as her practice mgmt company, to bill the insurances using 90806, 90847, 90804, etc. As a coder, I do not believe that these services are insurance billable because the codes are very specific as to "in an office or outpatient facility, face-to-face." Additionally, my concern is that some of her longtime patients have moved to states where the client is not licensed.

I have found nothing definitive in queries to various insurance carriers as to webcam psychotherapy although some have admitted that there is discussion regarding this but only for specific circumstances yet to be determined.

I am very interested in feedback from fellow coders... Is there something I am missing? Am I looking at the codes too narrowly? Is anyone aware that this practice is accepted or encouraged by any insurance? Do you believe that state licensure would be a liability factor?

Thanks for any and all responses.
Madison Area Chapter in Madison WI
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This falls under the telemedicine area. From a coding perspective, telemedicine services are coded with the appropriate code for services provided and the telemedicine modifier "GT" (Via interactive audio and video telecommunication systems for the service provided) For example, 90806-GT. The key here us real time interactive services. There are some exceptions to the real time rule, but at this point, it isn't important.

Now, for the reimbursement piece. Check with the carriers, especially your Medicare carrier, to learn their policies for telemedicine services. I am from a commercial carrier and we originally didn't cover telemedicine services, because we questioned the coding and medical appropriateness. A large provider group shared information with us and demonstrated how telemedicine works for some types of services (mental health therapy, for one). We now cover some telemedicine services. Our Medicare carrier does cover telemedicine services and their policies define the criteria.

In your client's case, they should only provide services where their licensure is appropriate. Now, given they are working within the scope of their licensure, they can provide, code, and submit these services. Reimbursement will depend on the carrier or the patient, if self pay is an option.

Hope this is helpful.