Reimbursement of Telepsychiatric Services

Telepsychiatry services are two-way, interactive video (or store-and-forward technology consultations) between a clinician and a patient. Psychiatry and behavioral health are particularly suitable applications for this technology. As more and more laptop computers come with built-in, high resolution cameras, telepsychiatric consultation has become increasingly feasible.

Medicare
As of Jan 1, 2009, Medicare will cover telepsychiatric services in nursing homes and community mental health centers.

Medicaid
State Medicaid programs may choose to include telemedicine as an optional benefit; currently, 24 states allow reimbursement of services provided via telemedicine for reasons that include improved access to specialists for rural communities and reduced transportation costs (http://www.cms.hhs.gov/home/medicaid.asp).

In the 24 states, the most common reimbursable services are behavioral/mental health diagnostic consultations or treatment. When billing for telemedicine, states generally use a modifier to existing CPT codes to identify a telemedicine claim. However, practitioners in some states that reimburse for telemedicine state that billing rules are complicated and repeated claims denials had discouraged some providers from seeking reimbursement.

Private Payers
Many private payers, including most Blue Cross plans, cover telepsychiatric behavioral services. However, there is no federal mandate to cover these services and not all payers will reimburse for them.