Mental health telehealth uses standard therapy CPT codes (90834, 90837) with modifier 95 for video or modifier 93 for audio-only sessions where allowed. Place of service code 02 can be used alternatively. Medicare covers mental health telehealth without geographic restrictions through 2025. Reimbursement rates are identical to in-person therapy. Audio-only reimbursement varies by state and payer; verify before billing.
Append modifier 95 to therapy codes for video-based synchronous telehealth. Use modifier 93 for audio-only therapy where payer-approved. Place of service code 02 (telehealth provider location) may be used instead of modifiers on some claims. Document the delivery modality (video, phone) in the patient record. Session length requirements are identical to in-person therapy. Audio-only coverage restrictions vary significantly by state and payer; always verify coverage before billing audio-only sessions.
Prior authorization for telehealth follows the same rules as in-person therapy. Session limits, per-visit copays, and coverage rules are generally identical between telehealth and in-person modalities under parity laws. Some payers require specific authorization for audio-only sessions. Verify telehealth-specific restrictions when obtaining authorization. Medicare has no geographic restriction on mental health telehealth through 2025.
Modifier 95 (telehealth) is appended to the therapy code, not used in place of other modifiers. Use modifier 25 on an E/M code if billed the same date as therapy. Modifier 93 (audio-only) requires payer approval and state law compliance. Do not bill both modifier 95 and 93 on the same claim. Telehealth modifiers apply to the entire session; do not append modifiers for partial telehealth sessions.
Document the delivery method (video, telephone) and platform used (if applicable). Note that session length and clinical content requirements are identical to in-person therapy. Include exact session times. Record any technical issues affecting the session. Document patient location if required by payer policy. For audio-only sessions, note the clinical justification for audio-only delivery where applicable.
Use modifier 95 for video-based synchronous telehealth. Append modifier 95 to the therapy CPT code (e.g., 90837-95).
Audio-only uses modifier 93 where payer-approved. Medicare and many commercial payers allow it. State laws vary; verify payer and state requirements before billing.
Yes. Medicare covers telehealth therapy without geographic restrictions through 2025. Audio-only and video are both covered. Reimbursement rates match in-person therapy.
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