Billing Insurance providers for video sessions
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Hello, I am now seeing all of my clients in Simple Practice video sessions. Can you tell me what CPT code and Place of Service code to use for sessions. Is there a different session duration that can be billed for video sessions?

Dr. Collins

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    Logan Foley

    Linda,

    I am in the same boat trying to understand all of this.  Will start billing teletherapy this week.

    I will try and provide my 2 cents here.  Anyone more educated on the topic please correct me if I am wrong.

    As an LPC, I will continue to utilize codes such as 90791 ,90837, 90834, etc for synchronous 2 way video sessions.  So no difference in CPT codes that I am aware of.

    As I understand it, most providing behavioral health services will use the modifier "95" in box 24 D of the claim form with a place of service in box 24 B of "02".  

    Perhaps Gillian or someone who already has experience billing teletherapy can help us out here.

    Logan

    Linda,

    I am in the same boat trying to understand all of this.  Will start billing teletherapy this week.

    I will try and provide my 2 cents here.  Anyone more educated on the topic please correct me if I am wrong.

    As an LPC, I will continue to utilize codes such as 90791 ,90837, 90834, etc for synchronous 2 way video sessions.  So no difference in CPT codes that I am aware of.

    As I understand it, most providing behavioral health services will use the modifier "95" in box 24 D of the claim form with a place of service in box 24 B of "02".  

    Perhaps Gillian or someone who already has experience billing teletherapy can help us out here.

    Logan

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    Gillian

    Thanks, Logan, for providing this information. You are correct - in almost all cases, you'll use the same CPT code to bill Telehealth that you would for in-office sessions. You'll need to adjust the Insurance Place of Service location to 02 for Telehealth (this is done automatically if you use SimplePractice's integrated Telehealth platform), as well as a 95 or GT modifier in box 24D, depending on the payer. 

    Thanks, Logan, for providing this information. You are correct - in almost all cases, you'll use the same CPT code to bill Telehealth that you would for in-office sessions. You'll need to adjust the Insurance Place of Service location to 02 for Telehealth (this is done automatically if you use SimplePractice's integrated Telehealth platform), as well as a 95 or GT modifier in box 24D, depending on the payer. 

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    Jennifer Bean

    Is the 95 modifier also automatic if I'm using SimplePractice's integrated Telehealth platform?

    Is the 95 modifier also automatic if I'm using SimplePractice's integrated Telehealth platform?

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    Jennifer Bean

    Nevermind! You answered this under a different topic. Sorry!

    Nevermind! You answered this under a different topic. Sorry!

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    Jennifer Bean

    And, sorry Again. I'm not used to posting here. It wasn't answered actually.  Do I need to go through and change each claim? I just tried generating a telehealth claim, and while the POS was changed to 02, the modifier of 95 was not automatically generated.  How do I turn this on?

    And, sorry Again. I'm not used to posting here. It wasn't answered actually.  Do I need to go through and change each claim? I just tried generating a telehealth claim, and while the POS was changed to 02, the modifier of 95 was not automatically generated.  How do I turn this on?

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    Diana Goldstein

    I'm following this thread, I've had several Aetna telehealth claims rejected because of lack of modifier, and I would like GT or 95 turned on automatically, so I don't have to manually go into each claim.  Help, Simple Practice!!

     

    I'm following this thread, I've had several Aetna telehealth claims rejected because of lack of modifier, and I would like GT or 95 turned on automatically, so I don't have to manually go into each claim.  Help, Simple Practice!!

     

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    Gillian

    Hi Jennifer, happy to clarify. The 95 or GT modifier isn't added automatically, so you'll want to create the claim, edit it, and enter the modifier manually. We're actively working on automating this process - you can vote for the idea to subscribe to updates on our Ideas board here: https://simplepractice.uservoice.com/forums/918553/suggestions/36554008

    Hi Jennifer, happy to clarify. The 95 or GT modifier isn't added automatically, so you'll want to create the claim, edit it, and enter the modifier manually. We're actively working on automating this process - you can vote for the idea to subscribe to updates on our Ideas board here: https://simplepractice.uservoice.com/forums/918553/suggestions/36554008

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    Sarah J. Rangel

    What if I don't use the simple practice Telehealth service, how can I document the place of service on Simple pRactice per patient if I am using Telehealth services such as text, email, and phone, besides webcam?

     

    What if I don't use the simple practice Telehealth service, how can I document the place of service on Simple pRactice per patient if I am using Telehealth services such as text, email, and phone, besides webcam?

     

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    Gillian

    Hi Sarah, you can create a new Office Location for these services under My Account > Settings > Practice Details. That way, you can distinguish these sessions on your Calendar, and auto-populate the correct Insurance Place of Service code on your claims. 

    Hi Sarah, you can create a new Office Location for these services under My Account > Settings > Practice Details. That way, you can distinguish these sessions on your Calendar, and auto-populate the correct Insurance Place of Service code on your claims. 

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    Suki Hall

    I have added the 02 and 95 modifier for Aetna and STILL the claims are rejected. Is there another code needed elsewhere? Or should I call Aetna to understand what is happening? Thanks so much - Simple Practice makes this all so much easier than if I were generating these claims myself!

    Suki

    I have added the 02 and 95 modifier for Aetna and STILL the claims are rejected. Is there another code needed elsewhere? Or should I call Aetna to understand what is happening? Thanks so much - Simple Practice makes this all so much easier than if I were generating these claims myself!

    Suki

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    Diana Goldstein

    For what it's worth, I've had decent luck calling Aetna last week and earlier today.  They have not been processing claims to include the copays so I've had the agents send back claims for 5 clients.  They said that my original claims did not have the telehealth codes, which they did.  I'm actually having to mail in a claim today.   I would call Aetna.  Good luck!

    For what it's worth, I've had decent luck calling Aetna last week and earlier today.  They have not been processing claims to include the copays so I've had the agents send back claims for 5 clients.  They said that my original claims did not have the telehealth codes, which they did.  I'm actually having to mail in a claim today.   I would call Aetna.  Good luck!

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    Ray Gottesman

    What is the difference between the 95 modifier and GT modifier and how do I know which to use?

    What is the difference between the 95 modifier and GT modifier and how do I know which to use?

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    Diana Goldstein

    My understanding is that 95 is synchronous, in real time, while GT is asynchronous, which wouldn't apply to us.

    My understanding is that 95 is synchronous, in real time, while GT is asynchronous, which wouldn't apply to us.

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    Ray Gottesman

    Thanks so much!

    Thanks so much!

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    Sarah Maloney

    Do we need to add the 95 modifier? I am trying to edit my claims so I can do batch claims, but i don't think I'm allowed to add 95 modifier? Annoying to have to edit several claims at once. 

    Do we need to add the 95 modifier? I am trying to edit my claims so I can do batch claims, but i don't think I'm allowed to add 95 modifier? Annoying to have to edit several claims at once. 

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    Sarah Maloney

    I only bill with Anthem and Medicare. 

    I only bill with Anthem and Medicare.