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:
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.
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, Director, Policy and Practice
Clinical Social Work Association firstname.lastname@example.org
PO Box 105Granville, Ohio 43023