What CPT Code(s) to Bill for Telehealth

March 27, 2020
Rick Gawenda

With many states mandating insurance plans in their state expand telehealth services and reimbursement to include physical therapy (PT), occupational therapy (OT) and speech therapy (ST) as well as several insurances expanding telehealth services and reimbursement on their own, I am being asked what CPT code(s) do I use to bill for telehealth services for physical, occupational and/or speech therapy services.

The answer is the one that you do not like. It is insurance carrier specific and you have to check with each insurance carrier and yes, this includes workers compensation. Codes that I am commonly seeing insurance companies mention are 97110, 97112, 97530 and 97535 for PT and OT and 92507 for ST.

I have also seen some insurance carriers list the 3 PT evaluation CPT codes (97161, 97162, 97163), the 3 OT evaluation CPT codes (97165, 97166, 97167) and 4 of the SLP evaluation CPT codes (92521, 92522, 92523, 92524).

The other thing you want to check with insurance carriers that are reimbursing for telehealth services for PT, OT and ST is in terms of is this only for current patients that were coming to the clinic or facility for therapy or can can telehealth be done for new patients and have the evaluations paid for by the insurance carrier. Also, is telehealth only reimbursable if you are an in-network provider or if you are out-of-network, will the insurance carrier pay the out-of-network benefit amount?

Lastly, many states have parity laws in place that require insurance carriers to pay for PT, OT and SLP at the same rate for telehealth services as they do if they patient came to your clinic or facility.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. We are being advised that since we bill for therapy services as employees of our hospital, we will not be reimbursed for telehealth services. I cannot find any documentation to support that, and multiple insurance payers have confirmed for California that they will reimburse for telehealth. Can you give me feedback on hospital billing for telehealth?

    1. If an insurance carrier is paying for telehealth, they are doing so for both private practice and non-private practice settings (i.e. hospitals). If you have specific questions, you would need to contact that insurance carrier. By using either Modifier GT or Modifier 95 (depending on insurance carrier requirement), that is how the insurance carrier would know you were doing telehealth.

  2. Every insurance company that I check refers to placing 02 for location of services rendered to indicate that the service was provided telehealth. On the UB-04 we are not able to report place of service. Just to clarify, the way for reporting location on the UB-04 is by attaching the applicable modifier or GT or 95 and each insurance company would need to give guidance as to which one they prefer/allow?