Telehealth Delivery of Mental Health Services
Overview
Telehealth is the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. Telehealth provides or supports health care delivery and facilitates the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care while the patient is at originating site and the licensed health care professional is at a distant site. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site.
Review the Telehealth Services section of the Minnesota Health Care Programs (MHCP) Provider Manual for an overview and requirements that apply to all telehealth services.
Eligible Providers
Eligible providers include any of the following:
Providers must self-attest that they meet all of the conditions of the MHCP telehealth policy by completing and submitting a Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible to provide and be reimbursed for services provided via telehealth.
Eligible Members
MHCP members eligible for mental health services can receive mental health services delivered through telehealth.
Covered Services
Mental health services covered by medical assistance as direct face-to-face services may be provided via telehealth and are covered by MHCP. For mental health services or assessments delivered through telehealth that are based on an individual treatment plan, the provider may document the client's verbal approval or electronic written approval of the treatment plan or change in the treatment plan in lieu of the client's signature.
Noncovered Services
See the Telehealth Services section of the MHCP Provider Manual for noncovered telehealth services.
Authorization Requirements
Authorization is required for mental health services delivered through telehealth if authorization is required for the same service through in-person contact.
Refer to the PA Indicator column on the MHCP Fee Schedule for procedures that always or sometimes require authorization.
Submit authorization requests to the Medical Review Agent. Authorizations are reviewed on a case-by-case basis.
The medical review agent uses nationally recognized criteria to determine medical necessity. It is the responsibility of the provider requesting authorization to submit sufficient documentation to establish that coverage standards have been met. Certain situations may require a unique piece of information that will aid the medical review agent in the decision-making process. Since it is impossible to identify all of the diverse information necessary for each case, the medical review agent will request additional information as the situation requires.
See the manual sections for specific mental health services for service limitations.
Billing
Providers should have a Telehealth Provider Assurance Statement (DHS-6806) (PDF) on their provider file beginning June 1, 2022, to bill claims for services provided via telehealth. Providers must have documentation of services provided and must have followed all clinical standards to bill for telehealth.
Place of service 02 (newly redefined): Telehealth provided other than the patient’s home. It’s the location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related service through telecommunication technology.
Place of service 10 (new place of service): Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.
When reporting a service with place of service 02 or 10, you are certifying that you are rendering services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.
New Telehealth Modifier and Use of Current Telehealth Modifiers
Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.
All other telehealth modifiers: All the other telehealth modifiers (GT, GQ, GO, 95) can be used for informational purposes but will not be required. The telehealth place of service codes explain that the service is rendered through telehealth. No telehealth modifiers can be used without place of service 02 or 10 or the claim will deny.
MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will pay zero.
Legal References
Minnesota Statutes 256B.0625, subdivision 46 (Mental Health Telehealth)
Minnesota Statutes 256B.0625 subdivision 3b (Telehealth Services)
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