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The COVID Emergency

is over! What happens to telehealth coverage?

It might not be as bad as you fear!


But, it's definitely a mix of "good news and bad news..."


Many states have enacted legislation protecting telehealth coverage. Some include commercial plans, while others only legislate Medicaid coverage.


The Center for Connected Health Policy is my go-to resource whenever I need information about telehealth. If you want to know what your state requires of private payers, they have the answer!


Keep in mind: plans vary WIDELY. Legal jurisdictions & governing entities are not always where (or who) you think they are. These charts are no substitute for asking the payer about your client's specific policy. But they're a good start. There's also information on the site about parity for telehealth, both coverage parity and payment parity (the bad news is that payment parity is still a long way from being universal, and that with the end of the PHE, this is where we will no doubt see the effects of a return to "normal.")


Check the State tab for information you may need about your state's Medicaid plan.


For Medicare, CCHP published a chart of all telehealth flexibilities, with dates on when each will expire, or has already expired. You can find it here. It's a great reference, and about as clearly explained as one is likely to get, with Medicare. If you really want the English translation, you'll need to attend my webinar on May 19th, where I'll go over it in detail. See below for registration information.


Be sure to read the footnote on the last page for some bad news ... If you've been conducting telehealth from home and have not yet registered your home address as a virtual service location with Medicare, you MUST do so by December 31, 2023.

Speaking of Medicare enrollment...


Attn: Counselors and Marriage/Family Therapists!


This week, I chatted with a friendly Provider Enrollment rep at one of the Medicare contractors. I asked her when Medicare would be opening up Enrollment for LPC's and LMFT's for 2024. Her answer: "CMS hasn't told us, which means it's not going to be soon." She advised everyone to wait for further information: Do not try to enroll now!


Medicare Rule # 1: The feds (i.e. CMS) are in charge. Once they make decisions, they tell the contractors what to do and how to implement it.


Attn: Everyone!


The PECOS 2.0 update scheduled for sometime this summer, might end up being delayed. The representative said there is no information at this time about the new release date. CMS's website still refers to "summer 2023." So I guess we wait & see. If you need to submit any enrollment updates, you should go ahead & do so using the current version.


PECOS = Medicare's online provider enrollment system (I won't bore you with the acronym...)

Welcome new subscribers!


May is Mental Health Month - Special sales to be announced soon!


Want your colleagues to receive our useful tips and access our sales? Tell them to Sign up here!


Free Coordination of Benefits rules guide for new signups!


(If you're already a subscriber, you won't miss out. Ask me to email you a copy.)

Struggling with Medicare?


Register now for

Medicare De-mystified!


May 19, 2023, 10 am Pacific / 1 pm Eastern


Your real-life questions answered!


  • Is being a Medicare provider is right for you?
  • Learn to decipher the Medicare fee schedule.
  • What services and conditions will Medicare pay for? Any limits?
  • Is the documentation REALLY that bad?
  • Audits!? Am I going to constantly be audited?
  • What is Medicare Advantage? How does it affect my practice?
  • Get Paid! How to fix claims / what to collect from clients.
  • What happens when Medicare is secondary?
  • Can I get out of taking Medicare?? (Yes! Find out how.)


AND ... How will you get paid for telehealth?


Get paid to coordinate your clients' care?!?



There are codes for Care management services for behavioral health conditions.


Psychiatrists, NP's, and other prescribers who bill evaluation & management (E/M) codes: use 99484. Psychologists, social workers: use G0323.


The codes differ, but the rules are the same: The clinician must document at least 20 minutes per month. Medicare will pay roughly $20-40, depending on the fee schedule in your zip code. Doesn't sound like much, but per client, per month, it could add up.


These four requirements must be documented for 99484 or G0323:

  • Utilize validated rating scale(s) for initial assessment and follow-up. This would include the PHQ-9, GAD-7, etc.
  • Evidence of treatment planning and revision based on ongoing monitoring and progress.
  • Coordination of treatment with other involved professionals.
  • Continuity of care with an appointed care manager or member of a care team.


Click here for more information.


Will private payers follow suit? Possibly. "Behavioral Health Integration" has been a goal for decades. Why not try including it in your billing? Copays/coinsurance will apply, so be sure to inform your client first and obtain their consent.


Note: 99484 and G0323 are NOT the same thing as Collaborative Care Management (typically abbreviated CoCM.) That's something else entirely, mostly for psychiatrists. 99484 and G0323 are referred to as "general" Behavioral Health Integration.

Who is Your Billing Buddy?

Have you ever wished for a biller who wouldn't charge you a percentage of every dollar you make? Someone you could count on when you get stuck?


I'm Susan Frager, Your Billing Buddy. I've spent 25 years as a mental health biller for practices in 23 states - I can help YOU, too!


You don't have to go it alone.


[email protected]

(360) 628-8612

Get help from your Buddy!

1420 Marvin Rd NE # C464

Lacey, WA 98516

(360) 628-8612

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