clinical social work association

December 16, 2022

LIST OF CHANGES TO MEDICARE TELEHEALTH SERVICES: January 1, 2023 (updated November 1, 2022)

Here is some new information on Medical Telemental Health Coverage in 2023.

Postponing the Effective Date of the Telemental Health In-Person Six-Month Rule

In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person “exam” requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met:

1. The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service starting 151 days after the end of the Public Health Emergency.

2. The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and

3. The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service starting 151 days after the Public Health Emergency.

While there is no requirement that this will apply to commercial insurance, they often follow the Medicare rules. At this time there are no insurers who have said they will require the above rules.

Behavioral Health

A new proposal is being finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists (CP) or clinical social workers (CSW). This code is to account for monthly care integration where the mental health services provided by a CP or CSW are serving as the focal point of care integration.

New Telemental Health Codes (Audio Only)

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

The following is a list of behavioral health ICD-10 codes that CMS will cover by audio-only through 2023 OR for 151 days after the end of the Public Health Emergency (PHE). To read the CMS statement go to the link above. Videoconferencing will be covered during the Public Health Emergency for the same codes that are used for in-person and also have 151 days after the end of the Public Health Emergency (PHE).

There are two new codes – 0362T And 0373T – which are connected to integrated medical and behavioral health care.

Code   Short Descriptor of Telemental Health Codes for Audio-Only CPT Codes

0362T Bhv id suprt assmt ea 15 min Available Through December 31, 2023

0373T Adapt bhv tx ea 15 min Available Through December 31, 2023

90785 Psytx complex interactive Available Indefinitely

90791 Psych diagnostic evaluation Available Indefinitely

90832 Psytx w pt 30 minutes Available Indefinitely

90834 Psytx w pt 45 minutes Available Indefinitely

90837 Psytx w pt 60 minutes Available Indefinitely

90838 Psytx w pt w e/m 60 min Available Indefinitely

90839 Psytx crisis initial 60 min Available Indefinitely

90840 Psytx crisis ea addl 30 min Available Indefinitely

90845 Psychoanalysis Available Indefinitely

90846 Family psytx w/o pt 50 min Available Indefinitely

90847 Family psytx w/pt 50 min Available Indefinitely

90853 Group psychotherapy Available Indefinitely

Please let me know if you have any questions about these changes to Medicare mental health coverage.

- Laura Groshong, LICSW, CSWA Director of Policy and Practice