Telehealth Psychiatry Billing: How Insurance Handles Online Psychiatric Visits

Online psychiatric visits are submitted to insurers with the same visit codes meant for in-person visits. Where lies the difference then? The claim needs to tell where the patient was and how the visit happened. The insurers, like Medicare, Kentucky Medicaid, and commercial plans have separate rules. For telehealth psychiatry billing, understanding the online psychiatry insurance coverage rules is important to ensure clean claims submission.

How Telehealth Psychiatry Visits Are Billed

The psychiatric visit code remains the same whether it is an online visit or an in-person visit. There are three visit types in psychiatric billing, each has a separate code and this code remains the same for telehealth. First is the evaluation that is done either by prescriber or a therapist. The prescriber can be a psychiatrist, psychiatric nurse practitioner, or PA. The code for prescriber is 90792. If a therapist or psychologist does the evaluation, the code is 90791.

The second one is medication management. If the follow-up visit is done with a prescriber, it is billed as the office code which is 99212-99215. When the prescriber does the therapy in the same visit, a second code is added based on the minutes spent in the therapy (90833/90836/90838). The minutes spent on therapy must be written down on their own. Psychiatric nurse practitioners can do all of these things under their name and Medicare pays 85% of the physician rate for their visits.

Modifiers and Place of Service

Place of service code is the two-digit code for where the service was offered to the patient. POS 10 when the patient is at home. POS 02 when the patient is somewhere other than home, like a clinic, or a school. A modifier is a two-character tag on the visit code that shows how the visit happened. Modifier 95 is used for live video and modifier 93 is audio-only phone visit. For the audio-only visit, a phone call is considered a visit for mental health under Medicare. The note should tell why audio was used instead of video. From January 01, 2027, Medicare telehealth claims will carry two new modifiers. BB is used when the telehealth service is furnished through a virtual platform that the practitioner contracts with or pays to use. BC is used when the service is furnished incident to a physician’s or practitioner’s service. Neither modifier changes the payment, as per the CMS Telehealth FAQ.

Coverage Differences by Payer and State

When the question comes to mind that how much the psychiatric visit is covered and what it will cost, the answer depends on the insurer involved. Let’s discuss the insurers separately.

Medicare

Mental health telehealth at home is “permanent” according to the Consolidated Appropriations Act of 2021. There are other telehealth flexibilities that will stay valid till December 31, 2027. However, from 2028, a Medicare patient needs an in-person visit within six months before the first telehealth visit. In the same way, one in-person visit is required every 12 months after the first remote visit. The patients who are a part of telehealth by the end of 2027 only need one visit in a year.

Kentucky Medicaid

The telehealth visit is paid at the same rate as in-person visit in Kentucky Medicaid. However, it can change with a managed care contract. Kentucky strongly encourages clinicians to use audio-only visits only when no other approved telehealth mode is available (KRS 205.559). This is not a ban on phone visits. Phone visits happen when there is no device, no internet connection, or the patient cannot manage it. When a phone visit happens, the payment is not equal to the video visit. If there is a CPT code in the rulebook for that type of phone visit, it is paid at a lower rate. At the patient’s end, the phone appointment is covered by the insurance but the clinician is paid less, so practices prefer the video call.

Kentucky Commercial Plans

Kentucky law (KRS 304.17A-138) requires a private health plan to pay for the telehealth psychiatry visit. The only case when the law requires it is when the private plan covers the same in the office. Another important thing is that the law requires the plan to pay at the same rate as the office visit unless the practice agrees to a lesser telehealth rate. The copay and coinsurance cannot be higher for the telehealth visit as compared to the same service in an office visit.

Common Reasons Telehealth Psychiatry Claims Are Denied

1. Incorrect modifiers play a strong role in getting paid for telehealth claims. These modifiers add clarity to how the visit happened. For example, if a video visit is submitted with the audio-only modifier, the claim describes the wrong kind of visit, and under Kentucky Medicaid it can be paid at the lower phone rate. If a phone visit is submitted as a video visit, it is paid first, but when the note is reviewed, the payment can be taken back.
2. The location codes are important and using these codes incorrectly leads to claim denials. These are the place of service codes and explain the location of the patient at the time of service. POS 02 on a visit that a patient took from home is paid at a lower facility rate by Medicare. The claim gets paid and it is never corrected. In another case where POS 11 is on the claim for a telehealth visit shows that the patient was in the clinic. The claim in this case comes back and it leads to recoupment or a claim denial.
3. Gaps in documentation are yet another reason behind claim denials. The documentation must entail that the visit was telehealth. The patient location should be mentioned correctly. Also, it should say whether it was audio-only or video visit. If there is a therapy add-on, it should be a part of the documentation with the therapy minutes. Missing any of these leads to denials and recoupments.
4. Some services need prior authorization from the plan whether the visit is online or not. Kentucky law stops the plan from requiring prior authorization just because the visit is online. Some in-person visits, intensive programs, and Medicare Advantage plans require authorization and this should be taken care of to avoid problems.

Practices that would rather not track all of these rules in-house use specialized psychiatric billing support.

Conclusion

Telehealth psychiatry billing should be accurate to get complete payments for remote visits. The codes for the in-person and telehealth visits are the same. The things that decide the payment are dependent on two things: where was the patient at the time of service and how the visit happened. The documentation should be accurate behind the claims. Most claim denials originate from one of these problems.

Sources

• https://www.cms.gov/files/document/telehealth-faq-updated-10-09-2026.pdf
• https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates
• https://www.cchpca.org/kentucky/

FAQs

Does insurance pay the same for a video psychiatry visit as an office visit?

The copay or coinsurance for telehealth cannot be greater than the office visit. Kentucky commercial plans must pay the same for video visits as per state laws, unless the practice agrees to a lower rate. For Medicare, the visit from home and the office is paid at the same rate since 2024.

Can I have my psychiatry visit by phone?

Yes, it can be done under Medicare in a case where video visit is not possible. The claim is submitted in this case as audio-only. Kentucky Medicaid covers the phone visit, but it encourages audio-only only when no other approved telehealth mode is available, and it can pay at a lower rate. Commercial plans set their own rules for phone visits, so check with the plan before the appointment.

Will I need to see my psychiatrist in person at some point?

Medicare patients need one in-person visit every 12 months from 2028. For new patients, one in-person visit is essential within six months before the first telehealth visit.