98966 – Telehealth / Remote Behavioral Health Service
CPT code 98966 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
98966
?
98966 is a CPT code designated for remote or virtual care services provided via telehealth. This code plays a crucial role in ensuring that clinicians can deliver high-quality mental health services while maintaining compliance with payer requirements. This entry details the clinical application of the code, documentation standards, and payer considerations that healthcare providers must adhere to. Clinicians are encouraged to align their clinical notes with evidence-based practices, ensuring that treatment goals, interventions, and measurable progress are clearly articulated. When billing is based on time, it is essential to document the start and stop times accurately to substantiate the billed duration.
Documentation Tips
When billing for time-based psychotherapy services using code 98966, it is vital to document both the start and stop times for the session. This ensures that the billed duration is clearly supported by the clinical documentation. Additionally, clinicians should include details regarding the therapeutic modality utilized or any assessment instruments applied during the session. Key elements to document include the clinical focus of the session, the patient's response to interventions, and a well-defined plan for follow-up care. For scored instruments, it is important to maintain copies of completed tools to substantiate progress. In the context of telehealth, be sure to document patient consent as well as the specific platform used for the session. Implementing consistent documentation structures, such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan), can enhance audit readiness and ensure the quality of documentation across the board.
At a Glance
- Service Type: Telehealth
- Use Case: Remote / Virtual Care
- Typical Setting: Outpatient clinic or telehealth (per payer policy)
- Billing Unit: Per session / per instrument (varies by code)
- Common Pairings: 90791, 96127, psychotherapy codes
Billing Examples
Documentation for a telehealth visit using CPT code 98966 should closely resemble the documentation practices of in-person visits. However, it is vital to include specific details about the telehealth platform used, obtain and record patient consent for telehealth services, and confirm that synchronous communication occurred throughout the session. For instance, if a clinician conducts a therapy session via a secure video conferencing platform, they should note the name of the platform, validate consent, and confirm that the interaction was real-time. It is essential to recognize that telephone consultations and asynchronous communications may require different codes and are often governed by distinct reimbursement policies, which necessitates careful attention to the specifics of each encounter.
Compliance Guidelines
- Before billing for services rendered, verify the payer's coverage and authorization requirements to ensure compliance.
- Accurately document medical necessity by linking all services provided to relevant ICD-10 diagnoses.
- Utilize appropriate modifiers, such as 95 for telehealth services, as mandated by payer guidelines.
- Avoid the practice of upcoding; always select the code that accurately reflects the documented time and level of service provided.
- Conduct regular audits of documentation practices to minimize the risk of claim denials and enhance the overall quality of clinical documentation.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F41.1
- F32.0
- Z04.8
- F43.21
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
Need more help? Reach out to us.
Q1: What is the primary purpose of this code?
A: CPT code 98966 is specifically used for remote care services that align with the definition set forth by the code. It is crucial to ensure that all documentation supports the billed service to meet payer standards.
Q2: Is this code eligible for telehealth billing?
A: Yes, many payers will reimburse for telehealth services using this code, provided that the service is delivered synchronously and that all necessary modifiers and patient consent documentation are in place. Always check the specific payer policy for confirmation.
Q3: What types of documentation might payers require?
A: Payers typically request documentation that includes the duration of the service, the therapeutic techniques or assessment instruments utilized, the patient's response to those interventions, and a clear connection to a covered ICD-10 diagnosis.
Q4: Can this code be billed in conjunction with other services?
A: Yes, when billing for multiple services, it is essential to document the distinct time and rationale for each service provided. Additionally, ensure compliance with any add-on codes or Evaluation & Management (E/M) separation rules that may apply.
Q5: What are common reasons for claim denials related to this code?
A: Common denial reasons may include inadequate documentation of time spent, lack of demonstrated medical necessity, incorrect use of modifiers, or billing for services that exceed frequency limits established by the payer.
