Telehealth Billing for Behavioral Health: Complete Guide to Virtual Service Claims

Virtual behavioral health services have become a cornerstone of mental health care delivery. For providers, the shift to telehealth brings both opportunities and challenges—particularly when it comes to billing. Getting paid for virtual services shouldn’t be complicated, yet many practices struggle with denied claims, delayed reimbursements, and confusing payer requirements.

The reality is that successful telehealth billing requires a clear understanding of specific codes, modifiers, and documentation needs. When you know how to navigate these elements effectively, you can focus more on patient care and less on administrative headaches. That’s why we’ve put together everything you need to know about billing for virtual behavioral health services, from the basics of telehealth claims to insurance-specific requirements and best practices for clean claims.

Understanding the Foundations of Virtual Behavioral Health Billing

Telehealth behavioral health services encompass any mental health care delivered through secure, real-time video platforms. While the clinical delivery may seem straightforward, the billing landscape presents unique challenges that require careful attention.

Key components of virtual claims include:

Proper documentation of virtual service delivery
Accurate application of telehealth-specific modifiers
Correct place of service codes
Platform compliance verification
Insurance-specific requirements

Common misconceptions often lead to claim denials. Many providers assume that telehealth billing follows the same rules as in-person services or that all insurance payers accept the same modifiers and codes. The reality is more complex—each payer may have distinct requirements for virtual services, and staying current with these variations is essential for clean claims.

Wondering if outsourcing your billing could improve your practice’s financial health? Learn more about the benefits of outsourcing behavioral health billing services.

Mastering Essential Coding Elements for Virtual Services

Successful telehealth billing hinges on understanding and correctly applying several key coding components. Let’s break down the critical elements:

CPT Codes for Behavioral Health Telehealth

The most commonly used CPT codes for virtual behavioral health services include:

90791: Psychiatric diagnostic evaluation
90837: Psychotherapy, 60 minutes
90834: Psychotherapy, 45 minutes
90832: Psychotherapy, 30 minutes
90847: Family psychotherapy with patient present
90846: Family psychotherapy without patient present

Telehealth Modifiers

Two primary modifiers indicate virtual service delivery:

Modifier 95: Indicates synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
Modifier GT: Used primarily for Medicare and some commercial payers to denote direct patient-provider interaction via interactive audio and video telecommunications

Place of Service (POS) Codes

Virtual services require specific POS codes:

POS 02: Indicates telehealth services provided to a patient at a location other than their home
POS 10: Used when telehealth services are delivered to a patient in their home

The interplay between these coding elements is unavoidable. For instance, a standard virtual therapy session might use CPT code 90837 with modifier 95 and POS 02 if the patient is connecting from their office. Understanding when and how to combine these elements ensures clean claims and timely reimbursement.

Streamlining Your Insurance Verification Process

Success in telehealth billing starts before the first virtual session. A robust verification process prevents claim denials and ensures you understand each payer’s specific requirements for virtual services.

Gather Patient Information: Before initiating the verification process, collect all relevant demographic details, insurance cards, and plan numbers.
Contact Insurance Providers: Call the behavioral health or provider services number on the back of the insurance card to verify coverage details.
Verify Telehealth Coverage: Confirm that virtual behavioral health services are covered under the patient’s specific plan and document any limitations.
Document Required Modifiers: Record which modifiers (95 or GT) the payer requires for virtual claims submission.
Check Authorization Needs: Determine if prior authorization is required and what documentation must be submitted.
Confirm Session Parameters: Verify any restrictions on session length, frequency, or total number of covered sessions.
Review Cost Sharing: Document patient responsibility for copays, coinsurance, or deductibles specific to telehealth services.

Insurance verification calls provide critical documentation that protects your practice and supports clean claims. Without proper records of these interactions, practices often struggle to dispute denied claims or resolve billing issues. Creating a standardized process for documenting verification calls helps ensure consistency and accessibility of important information.

Keep detailed records of all verification calls, including:

Date and time of verification
Reference number
Representative’s name
Specific coverage details discussed
Any special instructions for claims submission

Skipping insurance verification can lead to significant revenue loss and create an unnecessary administrative burden. Many practices learn this lesson the hard way, spending countless hours appealing denied claims that could have been prevented with proper upfront verification.

Navigating Payer-Specific Requirements

Ever wonder why a perfectly coded telehealth claim sails through for one insurance company but gets denied by another? The answer lies in understanding the unique requirements of each payer type. Let’s explore the distinct guidelines that shape telehealth billing across major insurance categories:

Medicare Requirements

Medicare coverage for telehealth behavioral health services includes:

No requirement for a GT modifier (only POS code needed)
Coverage for audio-only services in specific situations
Specific documentation requirements for virtual service delivery
Annual in-person visit requirements for ongoing virtual care

Medicaid Considerations

Medicaid requirements vary by state but generally include:

State-specific coverage policies
Varying modifier requirements
Different platform compliance standards
Specific provider enrollment requirements for telehealth

Commercial Insurance Guidelines

Commercial payers often have unique requirements, such as:

Payer-specific prior authorization processes
Different modifier preferences (95 vs. GT)
Varying platform requirements
Specific documentation standards
Network-specific rules for virtual services

Getting these payer differences right is what separates smooth-running practices from those drowning in denials. Smart practices keep a living document of each payer’s rules, updating it whenever policies shift. After all, in the behavioral health billing industry, what worked one year might not work the next.

Creating a Technology and Compliance Framework

Proper technology implementation and compliance measures are the foundation of successful telehealth billing. In behavioral health, having the right tech setup isn’t just about smooth video calls—it’s about building a system that supports clean claims while protecting patient privacy.

HIPAA-Compliant Platforms

Your telehealth platform must:

Provide secure, encrypted video connections with end-to-end protection
Include built-in documentation features for session notes and billing data
Support HIPAA compliance requirements through BAA agreements
Enable secure storage of session data with proper backup systems
Generate required session metrics for billing verification
Maintain detailed audit logs of all virtual sessions
Offer technical support for both providers and patients

Documentation Standards

Each virtual session requires detailed documentation to support billing claims and ensure compliance. Think of this as creating a digital paper trail that protects both your practice and your patients. Every session note should capture:

Precise start and end times of the virtual encounter
Specific platform used for service delivery
Patient’s physical location during the session
Provider’s location and credentials
Service delivery method (video or approved audio-only)
Any technical issues encountered and how they were addressed
Clinical documentation that supports medical necessity
Verification of patient identity and consent

Regular platform audits help identify potential compliance gaps before they become billing issues. Many practices find that combining robust technology with clear documentation protocols streamlines their workflow, making it easier to focus on what really matters—providing quality care to patients. When tech and compliance work together seamlessly, billing becomes less of a headache and more of a natural extension of your virtual practice.

Best Practices for Claim Success

Clean telehealth claims stem from a thoughtful submission process that spots potential issues before they reach the payer’s desk. Getting it right means building clear workflows that support both clinical care and billing integrity.

Here’s what winning practices do differently:

Documentation That Supports Payment

Every telehealth session needs specific elements in your notes:

Time-stamped session duration
Verification of patient location
Clinical justification for virtual care
Real-time service delivery confirmation
Patient consent for telehealth services
Any technology or connectivity issues that impacted care

Common Denial Triggers to Watch For

Look out for these frequent hurdles:

Incorrect modifier usage for specific payers
Missing or outdated authorization
Wrong place of service codes
Incomplete documentation of virtual service delivery
Outdated insurance information
Missing or incorrect provider credentials

Smart practices build prevention into their workflow. Double-checking common error points before submission saves countless hours of rework and helps maintain a steady cash flow. Setting up claim scrubbers and internal audits catches most issues before they hit the payer’s desk.

Elevate Your Virtual Behavioral Health Billing with SimiTree

The demands of telehealth billing shouldn’t hold your practice back from providing essential virtual care. At SimiTree, we’ve crafted a specialized billing solution that adapts to the unique challenges of virtual behavioral health services, ensuring maximum reimbursement while reducing your administrative burden.

Our comprehensive behavioral health billing services include:

Revenue Cycle Optimization: Expert handling of all billing requirements, codes, and modifiers to ensure clean claims and maximize reimbursement.
Payer-Specific Compliance: Dedicated teams stay current with evolving requirements across Medicare, Medicaid, and commercial payers.
Technology-Driven Solutions: Access our advanced billing platforms that integrate seamlessly with your practice management systems while meeting HIPAA requirements.
Authorization Management: Proactively handling prior authorizations and verification processes, reducing claim denials and revenue delays.
Dedicated Support Team: Work with specialists who understand the nuances of behavioral health billing and documentation requirements.

With SimiTree’s “No Claim Left Behind” approach, we’ve helped hundreds of behavioral health practices understand the complexities of virtual care billing. Our team brings a deep understanding of telehealth regulations, payer requirements, and the specific challenges faced by virtual behavioral health providers.

We leverage our extensive industry experience to ensure your practice maximizes reimbursement for virtual services. Our 450+ industry experts work tirelessly to stay ahead of telehealth billing changes, turning potential challenges into opportunities for revenue growth.

Transform your telehealth billing operations today. Contact SimiTree to discover how our specialized billing services can streamline your virtual care revenue cycle and support your practice’s continued success.

Frequently Asked Questions About Telehealth Billing

What modifiers should I use for Medicare telehealth claims?

Medicare has simplified its requirements—you’ll only need the appropriate place of service code (02 or 10). No additional modifiers are required unless specifically requested.

How do I bill for phone-only sessions?

Audio-only sessions have specific requirements that vary by payer. Medicare covers them in certain circumstances, but many commercial payers require video. Always verify coverage before providing audio-only services.

Do I need separate credentialing for telehealth?

Most payers don’t require separate credentials for telehealth services, but you should verify that your participation status includes virtual care coverage.