Evaluation and Management

Behavioral/Mental Health Services

  1. Can LCSWs use and bill for E/M codes such as 99212 or 99213?

    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. 
  2. Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home.

    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
  1. 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.
  1. 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.

Reviewed 7/5/2022