CPT Codes

Disclaimer:

The following list of potentially applicable CPT codes is provided for informational purposes only and should not be considered legal, medical, or billing advice. CPT codes are maintained by the American Medical Association (AMA) and are subject to updates, variations, and payer-specific requirements. Thrive Mental, LLC does not guarantee reimbursement or coverage for any specific CPT code. Insurance policies, provider contracts, and state regulations may impact the applicability of these codes. We strongly recommend that healthcare providers and organizations verify CPT code usage with the appropriate insurance carriers, regulatory bodies, and billing professionals before submission. For official CPT code definitions and guidance, please refer to the American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), and individual insurance payers.

UnitedHealthcare (UHC):

Covered Services: UHC reimburses for audio-only telehealth services when specific criteria are met.

Billing Requirements: CPT Codes: Use appropriate Evaluation and Management (E/M) codes for the services provided.
- Modifier: Append modifier 93 to indicate audio-only communication.
- Place of Service (POS) Codes: Use POS 02 (Telehealth Provided Other than in Patient’s Home) or POS 10 (Telehealth Provided in Patient’s Home).
- Reference: UHC Telehealth and Telemedicine Policy

Blue Cross Blue Shield (BCBS)

Covered Services: BCBS may cover audio-only telehealth services for mental health when deemed appropriate and when such coverage is mandated by state law.

Billing Requirements:
- CPT Codes: Providers should report the appropriate mental health service codes corresponding to the services rendered.
- Modifiers: The use of specific modifiers may be required to denote audio-only communication. For instance, some BCBS plans instruct providers to use modifier 93 for audio-only services.
- Premera
- Place of Service (POS) Codes: Providers are typically instructed to use POS codes such as 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home) when billing for telehealth services.

Elevance Health (formerly Anthem):

Covered Services: Elevance Health covers audio-only telehealth services for mental health when clinically appropriate.

Billing Requirements:
- CPT Codes: Report standard mental health service codes.
- Modifier: Use modifier 93 for audio-only services.
- POS Codes: Apply POS 02 or POS 10 as applicable.
- Reference: Elevance Health Virtual Visits Policy

CVS Health (including Aetna):

Covered Services: Aetna reimburses for audio-only mental health services under certain conditions.

Billing Requirements:
- CPT Codes: Use appropriate psychotherapy or E/M codes.
- Modifier: Apply modifier 93 to denote audio-only communication.POS Codes: Use POS 02 or POS 10.
- Reference: Aetna Telemedicine Policy

Cigna:

Covered Services: Cigna covers audio-only telehealth services for mental health when appropriate.

Billing Requirements:
- CPT Codes: Report standard mental health service codes.
- Modifier: Use modifier 93 for audio-only services.
- POS Codes: Apply POS 02 or POS 10.
- Reference: Cigna Virtual Care Reimbursement Policy

Humana:

Covered Services: Humana reimburses for audio-only mental health services when certain criteria are met.

Billing Requirements:
- CPT Codes: Use appropriate psychotherapy or E/M codes.
- Modifier: Apply modifier 93 to indicate audio-only communication.
- POS Codes: Use POS 02 or POS 10.
- Reference: Humana Telehealth Services

Kaiser Permanente:

Covered Services: Kaiser Permanente offers coverage for audio-only telehealth services, including mental health care, when deemed appropriate.

Billing Requirements:
- CPT Codes: Utilize standard mental health service codes.
- Modifier: Apply modifier 93 to denote audio-only services.
- POS Codes: Use POS 02 or POS 10 as applicable.
- Reference: Kaiser Permanente Telehealth Services

Health Care Service Corporation (HCSC):

Covered Services: HCSC, operating Blue Cross Blue Shield plans in multiple states, covers audio-only telehealth services for mental health when appropriate.

Billing Requirements:
- CPT Codes: Report appropriate mental health service codes.
- Modifier: Use modifier 93 for audio-only services.
- POS Codes: Apply POS 02 or POS 10.
- Reference: HCSC Telehealth Services

Centene Corporation:

Covered Services: Centene covers audio-only telehealth services for mental health when appropriate.

Billing Requirements:
- CPT Codes: Report appropriate mental health service codes.
- Modifier: Use modifier 93 to denote audio-only communication.
- POS Codes: Apply POS 02 or POS 10.
- Reference: Centene Telehealth Services

Molina Healthcare:

Covered Services: Molina reimburses for audio-only mental health services under specific conditions.

Billing Requirements:
- CPT Codes: Use standard psychotherapy or E/M codes.

Blue Shield of California:

Covered Services: Blue Shield of California covers audio-only telehealth services for mental health when clinically appropriate.

Billing Requirements:
- CPT Codes: Use standard mental health service codes.
- Modifier: Apply modifier 93 to indicate audio-only services.
- POS Codes: Use POS 02 or POS 10 as applicable.
- Reference: Blue Shield of California Telehealth Services

Highmark:

Covered Services: Highmark reimburses for audio-only telehealth services for mental health under specific conditions.

Billing Requirements:
- CPT Codes: Report appropriate mental health service codes.
- Modifier: Use modifier 93 to denote audio-only communication.
- POS Codes: Apply POS 02 or POS 10.
- Reference: Highmark Telemedicine Services

SCAN Health Plan:

Covered Services: SCAN Health Plan offers telehealth services through Doctor On Demand by Included Health®, providing members with access to licensed healthcare providers, including mental health professionals, via video or phone consultations. This benefit is available 24/7 and is suitable for urgent care needs as well as mental health and substance use concerns.

scanhealthplan.com

Billing Requirements:
- CPT Codes: For audio-only mental health services, appropriate CPT codes such as 98966–98968 (telephone assessment and management services) or 99441–99443 (telephone evaluation and management services by a physician or qualified healthcare professional) may be used, depending on the specific service provided.
- Modifier: Use modifier 93 to indicate that the service was provided via audio-only communication.
- Place of Service (POS) Codes: Apply POS 02 (Telehealth Provided Other than in Patient’s Home) or POS 10 (Telehealth Provided in Patient’s Home), as applicable.

Health Net:

Covered Services: Health Net reimburses for audio-only mental health services under certain conditions.

Billing Requirements:
- CPT Codes: Use appropriate psychotherapy or E/M codes.
- Modifier: Apply modifier 93 to indicate audio-only communication.
- POS Codes: Use POS 02 or POS 10.
- Reference: Health Net Telehealth Policy

Wellmark Blue Cross and Blue Shield:

Covered Services: Wellmark Blue Cross and Blue Shield offer virtual mental health services through Doctor On Demand®, providing access to board-certified doctors and therapists via smartphone, tablet, or computer. However, Wellmark does not cover audio-only telehealth services; services must include both audio and visual components to be eligible for reimbursement.

Billing Requirements:
- CPT Codes: Audio-only mental health services are not covered by Wellmark; virtual visits must include video.
- Modifier: Not applicable (audio-only services are not reimbursed).
- POS Codes: Not applicable (audio-only services are not reimbursed).
- Reference: Wellmark Telehealth Policy

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