Current Procedural Terminology (CPT) codes are standardized five-digit numerical codes used by healthcare providers to describe the services they deliver to patients. Accurate CPT coding is the foundation of medical billing and is particularly important for obtaining reimbursement from insurance companies. As mental health services increasingly move to virtual platforms, understanding how to code for telehealth psychotherapy is paramount. This process requires combining the standard service code with specific codes and indicators that communicate the remote nature of the visit to the payer.
Identifying Standard Psychotherapy Service Codes
The initial step in billing for any psychotherapy service is selecting the appropriate base CPT code, categorized primarily by the duration of the session. The most common codes used by mental health professionals are time-based codes for individual psychotherapy.
The code 90832 is used for a 30-minute session (16 to 37 minutes). Code 90834 is designed for a 45-minute session (38 to 52 minutes). CPT code 90837 represents a 60-minute session, billable for any session lasting 53 minutes or longer. These codes act as the core identifiers of the work performed, detailing the nature and length of the therapeutic encounter.
The Essential Telehealth Modifiers
After selecting the base CPT code, a specific modifier must be appended to signal that the service was delivered remotely. A modifier is a two-character code added to the end of a CPT code to provide additional information. For synchronous telehealth psychotherapy, which involves a live, real-time interactive audio and video session, the standard modifier is 95.
The 95 modifier, officially defined as “Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System,” is the primary way to inform the payer that the session was virtual. Most major commercial insurers, Medicare, and Medicaid now prefer or require this modifier for video-based visits. Historically, the GT modifier was used for the same purpose, but it is now largely considered a legacy code. Using the correct modifier directly affects how the claim is processed and whether the provider receives reimbursement.
Place of Service Codes for Remote Care
A claim form must include a Place of Service (POS) code, which indicates the physical location of the patient at the time the service was rendered. This data field is a crucial component of telehealth billing, as it often influences the reimbursement rate paid by the insurer. The Centers for Medicare & Medicaid Services (CMS) established two specific POS codes for telehealth services.
The code POS 02 indicates “Telehealth Provided Other than in Patient’s Home,” meaning the patient was at a work office, a school, or another facility. Conversely, POS 10 is designated for “Telehealth Provided in Patient’s Home,” applying when the patient is receiving the service from their private residence. Payers often base the payment amount on the POS code, recognizing the difference between facility-based and non-facility-based locations. Using the correct combination of the CPT code, the 95 modifier, and the appropriate POS code is necessary for a compliant telehealth claim submission.
Understanding Payer-Specific Rules and Exceptions
While the CPT codes, the 95 modifier, and the POS codes provide a standardized framework, the rules for telehealth reimbursement are not uniform and vary widely among different payers. Medicare has a complex and evolving set of guidelines, which historically included restrictions on the patient’s location and the type of provider. Even with recent changes, Medicare’s policies often serve as a benchmark but do not always align perfectly with other insurers.
Medicaid programs are administered at the state level and have significant variability. Each state determines its own list of covered telehealth services, approved modifiers, and registration requirements for out-of-state providers. Private insurance companies, such as Aetna or Blue Cross Blue Shield, maintain proprietary policies regarding which CPT codes are covered via telehealth and whether they prefer the 95 or the legacy GT modifier. This lack of standardization means a claim accepted by one payer may be rejected by another.
Coverage for audio-only psychotherapy sessions is a frequent point of exception, with many payers requiring a specific 93 modifier or a different set of CPT codes for telephonic-only visits. The specific rules are subject to rapid change, often updated annually or semi-annually. Providers must verify the current policy with each individual payer before submitting a claim to avoid rejections and ensure accurate reimbursement.