SPECIAL BULLETIN COVID-19 #19: Update to Telehealth Provisions: Clinical Policy Modifications

Friday, March 27, 2020

NOTE: SPECIAL BULLETIN COVID-19 #19 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Definitions, Eligible Providers, Services and Codes.

Effective March 30, 2020 through the conclusion of the declared North Carolina State of Emergency related to COVID-19, the Division of Health Benefits (DHB) and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) is temporarily modifying the Telemedicine and Telepsychiatry Clinical Coverage Policies to better enable the delivery of remote care to Medicaid and State funded beneficiaries. This bulletin is supplemental to Medicaid Special Bulletin #9 and is specific to Telepsychiatry only. Specific guidance related to billing and coding is detailed below. Once the declared State of Emergency has ended, all face-to-face elements of the service shall again be required to be performed in person.  

Providers can bill for these services starting March 30, 2020 for dates of service starting March 10, 2020. NC Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the State of Emergency period. 

Eligible telepsychiatry providers are being expanded to include the following associate level providers:

  • Licensed clinical social worker associate (LCSW-A)
  • Licensed clinical mental health counselor associate (LCMHC-A)
  • Licensed marriage and family therapist associate (LMFT-A)
  • Licensed clinical addiction specialist associate (LCAS-A)

Attachment A of the Telemedicine and Telepsychiatry Clinical Coverage Policy is being modified as follows:

The psychotherapy codes list is expanded to include the following codes:

  • 90839
  • 90840
  • 90846
  • 90847
  • 90849
  • 90853
  • 90785

These codes may be billed by licensed clinical mental health counselors (including associate level licensure), licensed psychologists, licensed psychological associates, licensed clinical social workers (including associate level licensure), licensed marriage and family therapists (including associate level licensure), licensed clinical addiction specialist (including associate level licensure), physicians, and psychiatric nurse practitioners.

In addition, LCSW-A, LCMHC-A, LMFT-A and LCAS-A clinicians may now also bill the following codes:

  • 90791
  • 90832
  • 90833
  • 90834
  • 90837

For licensed psychiatric prescribing providers (MD/DO Psychiatrists and PMHNP-BCs), the following inpatient professional codes may be billed under Telepsychiatry (requiring real-time 2-way audio/video). 

  • 99231
  • 99232
  • 99233
  • 99238
  • 99239

Modifiers

Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.

Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions.

Billing Unit

Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).

Place of Service

Telemedicine and telepsychiatry claims should be filed with place of service 02 (telehealth) and will be reimbursed at the same rates as if the service was performed in person.

Author: 
GDIT, (800) 688-6696