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Billing Terms Glossary
Telehealth Billing Terms: Definitions for Therapists and Psychiatrists
In this section
- 18 terms defined
- Written for psychotherapists and psychiatrists
- Source organization linked on every entry
Audio-Only Telehealth
General (all payers)Also called: telephone therapy; audio-only visit
- Definition
- A telehealth service delivered through audio without video, covered in some situations by some payers.
- Why it matters
- Coverage, modifiers, and POS rules differ and have changed.
- Illustrative example
- A patient without video access completes a session by phone under a payer's audio-only policy.
Time-sensitive: confirm current rules.
Related terms Modifier 93Modifier FQTelehealth
Reference source CMS (Centers for Medicare & Medicaid Services) · HHS (U.S. Department of Health and Human Services)
Categories Telehealth Terms
Digital Mental Health Treatment
General (all payers)Also called: DMHT; digital therapeutics
- Definition
- Use of software-based or digital tools as part of behavioral health treatment, with emerging billing codes in some programs.
- Why it matters
- Coverage is evolving and payer-specific.
- Illustrative example
- A payer covers a digital treatment device under a specific code.
Time-sensitive: confirm current codes and coverage.
Related terms TelehealthAI Scribe
Reference source CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsAI & Healthcare Automation Terms
Distant Site
General (all payers)Also called: provider site; telehealth distant site
- Definition
- The location of the clinician furnishing a telehealth service.
- Why it matters
- Some payers require the clinician's location to be reported or restricted.
- Illustrative example
- A therapist provides sessions from a home office.
Related terms Originating SiteTelehealth
Reference source CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsMedicare & Medicaid Terms
In-Person Requirement (Medicare Mental Health)
General (all payers)Also called: in-person visit requirement; six-month in-person rule
- Definition
- A Medicare rule that has required an in-person visit within a set period for certain mental health telehealth services, with timing and exceptions subject to change.
- Why it matters
- Missing an in-person requirement can jeopardize payment.
- Illustrative example
- A provider schedules an in-person visit before the deadline.
Time-sensitive: confirm current requirement and dates.
Related terms Telehealth FlexibilitiesOriginating Site
Reference source CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsMedicare & Medicaid Terms
Medicare Telehealth Services List
MedicareAlso called: CMS telehealth list; approved telehealth codes; Medicare telehealth eligible codes
- Definition
- The Medicare telehealth services list is the list of codes CMS allows to be billed when furnished by telehealth. Codes on the list can be billed with the proper modifier and place of service.
- Why it matters
- A code that is not on the list is not payable as telehealth by Medicare. The list and the rules around it have changed often, so confirm it before billing.
- Illustrative example
- A biller checks that a psychotherapy code is on the current list before scheduling a telehealth visit for a Medicare patient.
Time-sensitive: Medicare telehealth rules change. Confirm the current list and rules at CMS.gov.
Related terms TelehealthTelehealth FlexibilitiesTelehealth Modifier 95In-Person Requirement (Medicare Mental Health)
Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)
Categories Telehealth TermsMedicare & Medicaid Terms Medicare
Modifier 93
General (all payers)Also called: 93 modifier; synchronous audio-only
- Definition
- A modifier indicating a service delivered through real-time audio-only telecommunications.
- Why it matters
- Payers differ on whether and how they cover audio-only.
- Illustrative example
- A payer requires modifier 93 for phone sessions.
Verify: payer-specific.
Related terms Telehealth Modifier 95Modifier FQAudio-Only Telehealth
Reference source American Medical Association (AMA)
Categories Telehealth TermsClaims Processing
Modifier FQ
General (all payers)Also called: FQ modifier; Medicare audio-only mental health telehealth modifier
- Definition
- A modifier Medicare has used to identify mental health services furnished using audio-only communication.
- Why it matters
- Applies to Medicare audio-only rules, which have changed over time.
- Illustrative example
- A Medicare claim for an audio-only session carries FQ under current rules.
Time-sensitive: confirm current Medicare rules.
Related terms Modifier 93Audio-Only Telehealth
Reference source CMS (Centers for Medicare & Medicaid Services) · CMS HCPCS
Categories Telehealth TermsMedicare & Medicaid Terms
Modifier GT
General (all payers)Also called: GT modifier; via interactive audio and video telecommunications
- Definition
- A modifier some payers use to indicate services delivered by interactive audio and video.
- Why it matters
- Used by some payers instead of or in addition to modifier 95.
- Illustrative example
- A payer requires GT on telehealth claims.
Verify: payer-specific.
Related terms Telehealth Modifier 95Modifier 93
Reference source CMS (Centers for Medicare & Medicaid Services) · CMS HCPCS
Categories Telehealth TermsClaims Processing
Originating Site
General (all payers)Also called: patient site; telehealth originating site
- Definition
- Under Medicare telehealth rules, the location where the patient receives the service, historically subject to geographic and site restrictions with exceptions for mental health.
- Why it matters
- Site rules affect eligibility for Medicare payment.
- Illustrative example
- A patient's home is an allowed site for some Medicare mental health telehealth.
Time-sensitive: rules have changed; confirm at cms.gov.
Related terms Distant SiteTelehealth
Reference source CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsMedicare & Medicaid Terms
Place of Service 02
General (all payers)Also called: POS 02; telehealth other than home
- Definition
- The place of service code for telehealth provided other than in the patient's home.
- Why it matters
- Some payers require it when the patient is at a location other than home.
- Illustrative example
- A patient receives telehealth at a workplace and the claim uses POS 02.
Verify: payer rules on POS and payment differ.
Related terms Place of Service 10Place of Service (POS)Telehealth Modifier 95
Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Place of Service Code Set
Categories Telehealth TermsClaims Processing
Place of Service 10
General (all payers)Also called: POS 10; telehealth in patient's home
- Definition
- The place of service code for telehealth provided in the patient's home.
- Why it matters
- Some payers require POS 10 for home-based telehealth and pay it differently from POS 02.
- Illustrative example
- A patient receives therapy at home and the claim uses POS 10.
Verify: payer rules on POS and payment differ.
Related terms Place of Service 02Place of Service (POS)Telehealth Modifier 95
Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Place of Service Code Set
Categories Telehealth TermsClaims Processing
Public Health Emergency (PHE)
General (all payers)Also called: PHE; COVID public health emergency; telehealth emergency flexibilities
- Definition
- A public health emergency is a declaration by the HHS Secretary that lets the government use emergency authorities, including temporary flexibilities for Medicare and other programs. The COVID-19 declaration ended in May 2023.
- Why it matters
- Many telehealth rules began as PHE flexibilities and were later extended or changed by law or rule. Confirm the current status before you rely on one.
- Illustrative example
- A billing team checks whether a telehealth flexibility that began during the PHE still applies.
Time-sensitive: Confirm the current status of any telehealth flexibility.
Related terms Telehealth FlexibilitiesTelehealthAudio-Only TelehealthIn-Person Requirement (Medicare Mental Health)
Reference source HHS (U.S. Department of Health and Human Services) · CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsAudits & Compliance
Remote Patient Monitoring (RPM)
General (all payers)Also called: RPM
- Definition
- Use of devices to collect patient health data at home and send it to a provider, with specific billing codes.
- Why it matters
- Less common in behavioral health but present in integrated care.
- Illustrative example
- A clinic bills RPM for a patient's device readings where covered.
Related terms TelehealthCare Management
Reference source CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth Terms
Telehealth
General (all payers)Also called: telemedicine; virtual care; teletherapy; telebehavioral health
- Definition
- Delivery of health care services using real-time audio and video or other technology when the patient and clinician are in different places.
- Why it matters
- Coverage, codes, modifiers, and licensure rules vary by payer and state.
- Illustrative example
- A therapist sees a patient by video from the therapist's office.
Time-sensitive: rules change; confirm at telehealth.hhs.gov and cms.gov.
Related terms Telehealth Modifier 95Place of Service 10Telehealth Licensure
Reference source HHS (U.S. Department of Health and Human Services) · CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth Terms
Telehealth Flexibilities
General (all payers)Also called: Medicare telehealth waivers; telehealth extensions
- Definition
- Temporary or extended changes to Medicare telehealth rules, often set by Congress or CMS for defined periods.
- Why it matters
- Expiration dates affect billing rules and must be confirmed.
- Illustrative example
- A flexibility applies through a stated date unless extended.
Time-sensitive: confirm the current status and end dates at cms.gov and telehealth.hhs.gov.
Related terms Originating SiteTelehealth
Reference source CMS (Centers for Medicare & Medicaid Services) · HHS (U.S. Department of Health and Human Services)
Categories Telehealth TermsMedicare & Medicaid Terms
Telehealth Licensure
General (all payers)Also called: out-of-state telehealth; patient location licensure
- Definition
- The rule that generally requires a clinician to be licensed in the state where the patient is located when care is delivered.
- Why it matters
- Determines which patients a therapist can see by telehealth.
- Illustrative example
- A therapist licensed in one state cannot treat a patient located in another without authority.
Verify: state-specific.
Related terms Licensure CompactState License
Reference source HHS (U.S. Department of Health and Human Services)
Categories Telehealth TermsCredentialing & Enrollment
Telehealth Modifier 95
General (all payers)Also called: modifier 95; synchronous telemedicine modifier
- Definition
- A modifier indicating a service delivered through real-time, interactive audio and video telecommunications.
- Why it matters
- Many payers require it or an equivalent POS; requirements differ.
- Illustrative example
- A therapist appends modifier 95 to 90834 for a video session where required.
Verify: payer-specific.
Related terms Modifier GTModifier 93Place of Service 10Telehealth
Reference source American Medical Association (AMA)
Categories Telehealth TermsClaims Processing
Telepsychiatry
General (all payers)Also called: telepsychiatry; tele-psychiatry; psychiatric telehealth
- Definition
- Telepsychiatry is psychiatric care, such as evaluation and medication management, delivered through telehealth.
- Why it matters
- Billing follows the same E/M and psychotherapy codes with telehealth modifiers and place of service. Prescribing controlled substances by telehealth has its own federal and state rules.
- Illustrative example
- A psychiatrist bills 99214 with modifier 95 and the payer's telehealth place of service for a video medication visit.
Time-sensitive: Telehealth and controlled substance prescribing rules change. Confirm current rules.
Related terms TelehealthTelehealth Modifier 95EPCSDEA Registration
Reference source American Psychiatric Association · CMS (Centers for Medicare & Medicaid Services)
Categories Telehealth TermsBehavioral Health Specific Terms
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- Credentialing & Enrollment 58
- Contracting & Network Management 22
- Claims Processing 172
- Eligibility & Benefits 75
- Payment & Reimbursement 61
- Denials & Appeals 46
- Audits & Compliance 115
- Behavioral Health Specific Terms 148
- CPT, E/M & HCPCS Code Entries 54
- Revenue Cycle Metrics 44
- EDI & Clearinghouse Terms 63
- BCBS, UHC & Commercial Payer Terms 54
- Medicare & Medicaid Terms 145
- Value-Based Care Terminology 23
- Prior Authorization Terminology 22
- Quality & Risk Adjustment Terms 34
- EHR & Healthcare Technology Terms 54
- Provider Data Management Terms 26
- Patient Financial Responsibility Terms 35
- AI & Healthcare Automation Terms 12
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