Massachusetts Telehealth Billing for Therapists: 5 Easy Tips
Massachusetts telehealth billing for therapists is billing a plan for therapy or psychiatric care delivered by video or phone, under the rules of that plan and of Massachusetts law. For commercial plans, the state has a specific telehealth statute. For MassHealth, the Medicaid program, the rules sit in a separate regulation. This guide keeps the two apart and shows what to do on the claim.
What Massachusetts telehealth billing for therapists covers
The same visit can follow different rules depending on who pays. A commercial plan follows its contract and the state telehealth statute. MassHealth follows its regulations. Medicare follows federal rules, which change often and are not covered here. Start every telehealth claim by naming the payer type, then use the matching section below.
Private payers: what the state telehealth law says
M.G.L. c. 176I, section 13 is the Massachusetts telehealth coverage statute. The mass.gov page, which labels itself an unofficial version, says it was added by St. 2020, c. 260, section 54 and took effect on January 1, 2021. Read the statute text yourself, then use this table to turn it into billing steps.
| What the statute says | What to do in billing |
|---|---|
| Covered when the plan covers the service in person and it can appropriately be delivered by telehealth | Check telehealth coverage in your verification note for each plan |
| Plans may review telehealth for appropriateness, including preauthorization, but must use the same standard as for in-person care | If a plan asks for authorization only for telehealth, record the request and its reference number |
| Telehealth deductibles, copayments and coinsurance cannot exceed those for in-person care | Charge the same patient share for the visit whether it is video or in person |
| Plans must pay in-network behavioral health providers no less for audio-video and audio-only telephone services than for the same in-person services | Compare each telehealth remittance with the in-person rate for the same code |
| Providers need not document a barrier to an in-person visit, and patients may choose in-person care | Do not require a reason from the patient; offer both options |
Medicare and Medicaid: MassHealth telehealth rules
Massachusetts telehealth billing for therapists under Medicaid follows a different source of law than the commercial rules above.
For MassHealth, the independent clinician chapter is 130 CMR 462.000. Section 462.405 allows psychotherapy by telehealth. Section 462.402 defines telehealth to include synchronous or asynchronous audio, video and other technology, including audio-only telephone. Services may happen in an office, the member’s home, another suitable facility, or by telehealth. The chapter’s other limits still apply, such as one payable visit of a single service type per member per date of service.
Medicare telehealth rules change frequently, so check the current CMS guidance before you bill a Medicare patient by video. Do not copy a commercial or MassHealth rule onto a Medicare claim.
How to get telehealth claims paid
Massachusetts telehealth billing for therapists fails on small details. Ask each plan three questions during verification: which place of service code and modifier it wants, whether it covers audio-only visits, and whether it requires authorization for telehealth. Our insurance verification routine and patient benefit verification questions give you a script. Record the answer by plan so your biller applies it every time.
Then document how each visit was delivered. One example: WellSense’s behavioral health manual for providers (September 2021 edition) requires treatment records to show the modality, such as telehealth video or phone. Many plans ask for the same. A note that says “session” with no modality can cost you the claim.
Collecting the patient share in Massachusetts telehealth billing for therapists
Because the statute caps telehealth cost sharing at the in-person amount, set one copay policy per plan. Take the copay at the visit, either by card on file or through your payment link. Hold coinsurance until the plan’s remittance shows what it applied. Check your clean claim rate after any change to your telehealth setup, since new workflows tend to create new errors.
Is telehealth covered in Massachusetts?
Yes, for the plans described above. For Massachusetts telehealth billing for therapists, commercial plans must cover telehealth when the same service is covered in person and can appropriately be delivered by telehealth, and MassHealth allows psychotherapy by telehealth under 130 CMR 462.405. The details that decide payment are the plan’s modifier, place of service and authorization rules, so confirm them before the first claim. Use the insurance companies contact directory to find the right line, and read denials with our guide to claim adjustment reason codes.
What to do Monday morning
- List every plan you bill for telehealth under Massachusetts telehealth billing for therapists and note its modifier, place of service and authorization rules.
- Check that each telehealth note records the modality.
- Compare three recent telehealth remittances with the in-person rate for the same code.
- Confirm your telehealth copay matches your in-person copay for each plan.
The short version: Massachusetts telehealth billing for therapists
Massachusetts telehealth billing for therapists starts with the payer type. Commercial plans follow the state telehealth statute, MassHealth follows 130 CMR 462, and Medicare follows federal rules. Document the modality, ask each plan for its modifier and place of service, and check your remittances against the in-person rate.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients. If telehealth claims are denying and you cannot tell why, we can talk through your setup.
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Related reading
Want help with telehealth claims? We can talk through your practice.
FAQ
Do Massachusetts commercial plans have to cover telehealth for therapy?
M.G.L. c. 176I, section 13 says covered services that can appropriately be delivered by telehealth must be covered for plans within the section. Confirm with each plan how it applies.
Can a plan charge a higher copay for telehealth than for an in-person visit?
The statute says telehealth deductibles, copayments and coinsurance cannot exceed those for in-person care. Charge the same patient share for the same service, and confirm with the plan.
Does MassHealth cover audio-only therapy?
130 CMR 462.402 defines telehealth to include audio-only telephone, and 462.405 allows psychotherapy by telehealth. A MassHealth plan may add rules, so ask the plan.
Which modifier and place of service code should I use for telehealth?
It depends on the plan. Ask each plan during verification, record the answer and apply it to every claim for that plan.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
