Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, mental health and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.
CalVCB typically allows up to five telehealth sessions per application. Once a claimant reaches five sessions, the treating mental health provider must request additional telehealth sessions by submitting a Telehealth Therapy Verification form. Providers must also submit a Treatment Plan (see COVID telehealth for rules in place during the stay-at-home order.) Telehealth sessions do count against the claimant’s current mental health session limit.
CalVCB will email providers with the request decision. A submission requesting additional telehealth sessions does not automatically authorize additional telehealth sessions.
For billing, the following CPT codes are used for “telephone assessment and management service provided by a qualified non-physician health care professional to an established client, parent or guardian.”
These CPT codes are reimbursable for mental health telehealth sessions when billed with modifier “GT”:
- 98968: Telehealth, non-psychiatrist
- 99443: Telehealth, psychiatrist
Other codes may also be used for telehealth, using the modifier “95.”
- 90791: Intake – Psychiatric diagnostic interview examination
- 90792: Intake – Psychiatric diagnostic interview examination with med management
- 90832, 90834, 90837: Individual psychotherapy
- 90846: Family psychotherapy without the patient present
- 90847: Family psychotherapy with the patient present
- 90853: Group psychotherapy
CPT Codes and modifiers are indicated in box 24D “Procedures, Services, or Supplies.”
Use the POS code “02” in box 24B “Place of Service.” While POS code “02” is recommended, CalVCB may also accept other POS codes (e.g., POS code 11 – Office).
All telehealth sessions must meet Health Insurance Portability and Accountability Act compliance. The Board of Behavioral Sciences and Board of Psychology have specific requirements related to the provision of telehealth for all licenses. For relevant statutes and regulations governing the provision of telehealth posted by the Board of Behavioral Sciences and Board of Psychology, contact the agency governing your licensure.
If the claimant already saw another provider for this qualifying crime, the claimant may have already used the initial three sessions.
If a service provider determines the treatment is not 100% related to the qualifying crime:
- The provider must inform CalVCB.
- The provider must inform the claimant of the percentage of treatment related to the qualifying crime.
CalVCB payments will reflect the percentage that is indicated by a provider as related to the crime.
CalVCB has the authority to collect or off-set overpayments for any treatment that is not directly related to the qualifying crime.