- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Frequently Asked Questions Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
Behavioral/Mental Health Services
- Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home.
Note: CMS has extended the PHE-period waiver for in-person visit requirements for telehealth mental services through CY 2024. Please remain aware that these requirements will be in effect for CY 2025, at which point additional information will be made available.
Answer: In order to meet CMS guidelines, the mental health practitioner furnishing such services must have furnished both:
The provider must document any valid exception to these rules in the beneficiary’s record. Of note, the face-to-face visit requirement may be fulfilled by a clinician’s colleague of the same specialty and in the same group if the original provider is available. Please see FAQ #4 for further details on technology requirements for mental health practitioners providing services to beneficiaries at home.
- An in-person, non-telehealth service to the beneficiary with the 6-month period before the date of the telehealth service
- An in-person, non-telehealth service to the beneficiary within a 12-month period after the telehealth service, and within every 12-months thereafter while performing telehealth services
Note: Post-PHE, CMS has waived in-person visit requirements for telehealth mental services through CY 2024.
- May LCMH providers independently perform and bill behavioral health services?
Answer: Yes, as of 1/1/2024, LMHC providers may enroll in Medicare and bill Medicare independently. MHC providers may also still provide services and supplies as auxiliary personnel incident to a physician or NPP.
- Can LCSWs use and bill for E/M codes such as 99212 or 99213?
Answer: The elements of E/M services (history, examination and MDM) are not within the scope of service for LCSWs and these services may not be billed by these providers at any level.
- Please define technology requirements are in place for providers who perform telehealth mental health services for beneficiaries at home.
Answer: Providers who perform such services must have access and capability to use interactive telecommunication technology that includes both audio and visual two-way, real-time communication capability. Exceptions to this rule are based on the beneficiary’s capability and agreement, as follows:
- The beneficiary may not be capable of audio/video communication OR the beneficiary may not consent to audio/video communication.
- In either of these circumstances, the provider must provide documentation in the patient’s medical record.
- Please describe modifiers applicable for telehealth mental health services provided to a beneficiary who is at home.
Answer: The following CMS modifiers apply in these instances:
- Modifier FQ: a telehealth service was furnished using real-time audio-only communication
- Modifier FR: a supervising practitioner was present throughout a real-time two-way audio/video telehealth service.
Note: Modifiers FQ and FR are required on these claims as of 4/1/2022.
Revised 4/17/2024