98968 – Telehealth / Remote Behavioral Health Service
CPT code 98968 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
98968
?
98968 is designated for remote or virtual care services provided through telehealth platforms. This code plays an essential role in ensuring that patients receive timely and effective mental health care, particularly when in-person visits may not be feasible. The following entry elaborates on the clinical applications of this code, the necessary documentation standards, and considerations from a payer perspective. Providers are encouraged to ensure that clinical notes are consistent with evidence-based practices, documenting treatment goals, interventions applied, and measurable outcomes. When billing for services based on time, it is crucial to accurately record the start and stop times to validate the duration billed.
Documentation Tips
When billing for time-based psychotherapy under the code 98968, it is essential to thoroughly document the start and stop times of the session. This practice not only ensures compliance but also supports the validity of the billed duration. Documentation should also include the specific therapeutic modality utilized or the assessment instrument administered, alongside the clinical focus of the session. It is beneficial to detail the patient's response to interventions and outline a plan for follow-up sessions. For any scored instruments, maintain copies of the completed assessment tools as part of the patient's record. In the context of telehealth, it is imperative to document patient consent for virtual services as well as the specifics of the technology or platform used during the session. Employing a consistent structure for documentation, such as the SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan) formats, will enhance audit readiness and overall documentation quality.
At a Glance
- Service Type: Telehealth
- Use Case: Remote / Virtual Care
- Typical Setting: Outpatient clinic or telehealth (subject to payer policies)
- Billing Unit: Session-based or per instrument (may vary by specific code)
- Common Pairings: 90791, 96127, psychotherapy codes
Billing Examples
An example of utilizing code 98968 in telehealth would involve a mental health clinician providing a therapy session via a secure video conferencing platform. The clinician’s documentation should mirror that of an in-person visit, while also capturing essential details such as the consent for treatment provided through telehealth and verification of synchronous communication. It is crucial to note that while telehealth permits remote engagement, different codes may apply for telephone-only or asynchronous communications, each having distinct reimbursement guidelines. For instance, if a clinician conducts a follow-up session via phone, they may need to utilize a different CPT code that aligns with that specific mode of communication.
Compliance Guidelines
- Before billing, confirm the payer's coverage policies and authorization prerequisites to avoid billing denials.
- Clearly document the medical necessity for the service provided and ensure that all services are linked to appropriate ICD-10 diagnoses.
- Apply the correct modifiers as required by payers, such as modifier 95, which designates telehealth services.
- Avoid upcoding practices—always select the code that accurately reflects the documented time and level of service provided.
- Conduct regular audits of billing practices and documentation to reduce denials and enhance the quality of clinical notes.
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.
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Q1: What is the purpose of CPT code 98968?
A: CPT code 98968 is utilized for telehealth services when the clinical activities meet the definition of the code. It is essential that all documentation justifies the billed service appropriately.
Q2: Is CPT code 98968 eligible for telehealth billing?
A: Yes, a majority of payers will reimburse for services billed under this code when the service is delivered synchronously and all required modifiers and consent documentation are accurately recorded. Always consult the specific payer policy for confirmation.
Q3: What documentation may payers request for this code?
A: Payers typically request comprehensive documentation that includes the time spent on the service, the therapeutic techniques or instruments utilized, the patient's responses to interventions, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can CPT code 98968 be billed alongside other services?
A: Yes, when billing multiple services, it is crucial to document distinct time spent and justification for each service billed. Additionally, utilize add-on codes or adhere to Evaluation and Management (E/M) separation rules where applicable.
Q5: What are common reasons for denial related to this code?
A: Common denial reasons include insufficient documentation of time spent, lack of medical necessity, incorrect use of modifiers, or billing that exceeds frequency limits imposed by payers.
