Hawai‘i Psychological Association Insurance Telehealth FAQ’s

Version Date: 5/1/20

This is the most current & best information that we have at this time; please check back regularly for updated
information.

HMSA:

1. Billing: All psychotherapy CPT codes can be delivered via telehealth (HIPAA compliant
when possible, but FaceTime and Skype are allowable) or telephone (no video
component) using the modifier=95 and POS=2.
2. Rates: The reimbursement rates are the same as in-person sessions.
[HRS§431:10A-116.3(c): “Reimbursement for services provided through telehealth shall
be equivalent to reimbursement for the same services provided via face-to-face contact
between a health care provider and a patient.” ]
3. Co-pays, co-insurance, deductibles, and GET: All co-pays, co-insurance, and
deductibles for telehealth visits have been eliminated at this time. When you bill HMSA,
they will pay 100% of the eligible charge. You can continue to process GET on the
maximum allowable charge for HMSA PPO patients seen via telehealth. [4/14/20 update:
we have been unofficially informed that HMSA is still determining if all HMSA Online Care
co-pays will be waived & that when HMSA made the statement that they were waiving all
telehealth co-pays, this refer to HOC visits. Therefore, if clients are prompted to pay a co-
pay through HOC (most will not), that this is likely correct & they should pay that co-pay
amount.]
4. New Patients: New patients can be seen for a 90791 utilizing telehealth/telephone. No
initial face-to-face visit is required.
5. Age Restrictions: There are no age-restrictions for use of telehealth. HMSA Online Care
(HOC) has a stipulation (imposed by the state) that Quest minors cannot utilize the HOC
portal. They are looking to overrule this. You can, however, use other telehealth/telephone
platforms with Quest minors and bill as above. [We have confirmed that commercial (PPO,
HMO) and Quest (except Quest minors as explained above) are eligible for HOC and have
requested confirmation re: eligibility of Federal Plan or Akamai Advantage for HOC - you
can still use other telehealth platforms for those plans in the meantime. Unofficially, some
providers have been told that the HOC systems has been opened to all HMSA Federal
Plan members, and it does in fact appear to be working & reimbursing for some, if not all,
of those members.]
6. Group Therapy: Psychologists may bill for online group therapy as well, using the
modifiers and expect the same reimbursement rate as face-to-face.
7. Telephone-Only: Allowed, see above for billing & reimbursement.
8. Other Codes: While primarily billed by physicians, psychologists can also bill for these
additional services with no modifier. However, these are all billed at a much lower rate
than the psychotherapy codes.
o G2061-63 (online assessment services)
o 99446-49 (consultation)
o 98966-68 (telephone assessment and management service)

KAISER:

1. Billing: Billing of claims with telemedicine services require appropriate psychotherapy CPT
code, using the modifier=GT and POS=2.
2. Rates: The reimbursement rates are the same as in-person sessions.
3. Co-pays, co-insurance, deductibles, and GET: All co-pays, co-insurance, and
deductibles for telehealth visits should continue to be billed to patients as usual.
4. New Patients: Affiliated care providers can provide telemedicine with their existing
patients they have already established face to face physician-patient relationship with,
provided that you are using a HIPAA compliant platform.
a. For diagnostic evaluations (first time appointments), unless you have received a
notification from us that the patient has been seen internally by a provider and is being
referred to you for telemedicine, you should still see the patient face to face first to
establish physician-patient relationship, per the state law. Therefore, if you are a
contracted behavioral health psychologist or licensed clinical social worker, patients have
to have a face to face encounter with the provider before telemedicine can be done. The
Kaiser behavioral health department is awaiting action by the State to hopefully waive that
requirement. Until then it is our understanding that the federal law does not waive the
State requirements.
The text that has been striken-through above in item 4 has been superseded by the
Govenor’s Executive Order No. 20-02 as of 3/29/20, which waives the state statute that
requires initial encounters must be conducted in person. This means that initial intake can
be conducted via telehealth during this time.
5. Age-restrictions: No information available at this time, will be updated if information
obtained.
6. Group Therapy: No information available at this time, will be updated if information
obtained.
7. Telephone-Only: Not allowed. Only allowing use of technology that fits within the
definitions of telehealth in our state law: encompass four modalities: store and forward
technologies, remote monitoring, live consultation, and mobile health; and which shall
include but not be limited to real-time video conferencing-based communication, secure
interactive and non-interactive web-based communication, and secure asynchronous
information exchange, to transmit patient medical information, including diagnostic-quality
digital images and laboratory results for medical interpretation and diagnosis, for the
purposes of: delivering enhanced health care services and information while a patient is
at an originating site and the physician is at a distant site; establishing a physician-patient
relationship; evaluating a patient; or treating a patient. 4/17/20 update - Gov Ige's EO #20-
04 of April 17th suspends the following laws in section 1(f): Sections 346-59.1, 431:10A-
116.3, 432:1-601.5, and 432D-23.5, HRS, relating to coverage for telehealth, to the extent
that the definitions of “telehealth” in each section shall exclude the use of standard
telephone contacts. See: https://governor.hawaii.gov/wp-
content/uploads/2020/04/2004089-ATG_Executive-Order-No.-20-04-distribution-
signed.pdf 5/1/20 update: Kaiser follows Medicare rules, and Medicare is now allowing
 telephone only. Reimbursement for telehealth visits will follow regulatory guidelines: Use
POS 02 and/or modifiers 95, GT, GQ or GO as appropriate on your claim to indicate a
telehealth service was provided. This will ensure there is no cost share to the member.
Continue your current billing practice (procedure & diagnosis codes) to receive your
current contracted rate. During this period, Kaiser Permanente supports the use of
telephonic visits.

AlohaCare:

1. Billing: All psychotherapy CPT codes can be delivered via telehealth (HIPAA compliant
when possible, but FaceTime and Skype are allowable) or telephone (no video component)
using the modifier=95 and POS=2.
2. Rates: The reimbursement rates are the same as in-person sessions.
3. Co-pays, co-insurance, deductibles, and GET: Not applicable.
4. New Patients: New patients can be seen for a 90791 utilizing telehealth/telephone. No
initial face-to-face visit is required.
5. Age-restrictions: There are no age-restrictions for use of telehealth.
6. Group Therapy: Psychologists may bill for online group therapy as well, using the modifiers
and expect the same reimbursement rate as face-to-face.
7. Telephone-Only: Allowable with psychotherapy CPT plus modifier=GQ. Not sure of
reimbursement rates yet.

UHA:

1. Billing: All psychotherapy CPT codes (e.g., 90791-2, 90832-8, 90845, 90846-7) can be
delivered via telehealth (HIPAA compliant when possible, but FaceTime and Skype are
allowable) or telephone (no video component) using the modifier=95 and POS=2.
2. Rates: Reimbursement to the health professional delivering the clinical service is the same
as the current fee scheduling amount for the service provided.
3. Co-pays, co-insurance, deductibles, and GET: All plan provisions, exclusions, payment
guidelines, and negotiated agreements required for in-person visits also apply to services
delivered through telemedicine. As of 3/27/20 all co-pays are waived for telemedicine
encounters for the duration of the COVID-19 state of emergency regardless of the primary
purpose of the visit.
4. New Patients: New patients can be seen utilizing telehealth/telephone. No initial face-to-
face visit is required.
5. Age-restrictions: No info obtained.
6. Group Therapy: No info obtained.
7. Telephone-Only: Allowed, see above for billing/coding guidance.

HMAA: We are recommending that providers call HMAA to determine a patient has telehealth
for psychotherapy coverage under their plan. There are some self-funded groups (like unions
and other organizations) and they decide what benefits to provide for their members. Some
have chosen not to have telehealth benefits for their employees. In an 4/7/20 email
communication a HWMG Provider Relations Specialist indicated that “At this time, all of our
members and TPA clients have telehealth benefits and claims will be paid based on the
member's specific benefit guidelines and the provider's contracted rates.”
1. Billing: We can use standard psychotherapy CPTs when billing for telepsychology, for
initial intake as well as F/U sessions, with the modifier=95 and POS=2. As of 4/7/20
HWMG’s system has been updated with all valid telehealth codes as well as those that were
created specifically during this pandemic. You may use any telehealth platform to provide
services to the patient – it is requested that an approved telehealth platform is used as much
as possible however as long as your claim includes the appropriate, valid telehealth codes
then the claims will be processed according to the patient's plan benefits and provider's
contracted rates.
2. Rates: Telehealth reimbursement rates are the same as in-office visits.
3. Co-pays, co-insurance, deductibles, and GET: Same co-pay and GET as in-office visits.
4. New Patients: Do not need a referral and do not need first session to be in-person.
5. Age-restrictions: None
6. Group Therapy: Coverage is the same as in-person groups. As long as it is a covered CPT
code, they will cover it for telehealth.
7. Telephone-Only: Audio-only session have not been authorized. 4/17/20 update - Gov Ige's
EO #20-04 of April 17th suspends the following laws in section 1(f): Sections 346-59.1,
431:10A-116.3, 432:1-601.5, and 432D-23.5, HRS, relating to coverage for telehealth, to the
extent that the definitions of “telehealth” in each section shall exclude the use of standard
telephone contacts. See: https://governor.hawaii.gov/wp-content/uploads/2020/04/2004089-
ATG_Executive-Order-No.-20-04-distribution-signed.pdf

MEDICARE (These changes do not necessarily apply to 3 rd-party/commercially-administered

Medicare plans, e.g., HMSA Akamai Advantage):
1. Telehealth AND Audio-Only Telephone Billing: All psychotherapy CPT codes can be
delivered via telehealth (HIPAA compliant when possible, but other video call platforms -
such as Skpe - are allowable) or telephone (only when there is audio AND video capability,
such as FaceTime) using the modifier=GT and POS=2. Location restrictions for providers &
patients have been waived during this time. Effective 3/30/20 the psychotherapy CPT
codes below can be delivered via telehealth (HIPAA compliant when possible, but other
video call platforms - such as Skpe - are allowable) or telephone (only when there is audio
AND video capability, such as FaceTime). Effective 3/31/20 providers furnishing services
through telehealth should use the POS that would have been reported if the service had
been furnished in-person. CMS is making this change to identify when it is appropriate to
pay a non-facility fee, rather than a facility fee which would have automatically been
included under POS=02. I.e., a psychologist who would have seen patients in a private
office should use POS=11. Those who would have treated the patient in a clinic or skilled
nursing facility should use the corresponding POS. All claims for telehealth services should
now use modifier=95. Effective 4/30/20, psychologists can now provide many of their typical
services by audio-only telephones using same POS & modifiers as for video sessions.
These phone only services will now be reimbursed for Medicare beneficiaries. Phone only
services may be retroactive to March 1, 2020 (updates on this will be provided when
available). Psychologists should bill Medicare for traditional telehealth or phone only
services the same way they bill for an office visit by using the appropriate CPT code for the
service provided. At this time, Medicare is allowing the following mental and behavioral
health services to be provided via telehealth in three categories:
(1) CPT Codes Allowed via Phone Only and Traditional Telehealth
• Diagnostic Interview (90791, 90792)
• Psychotherapy (90832, 90833, 90834, 90836, 90837, 90838)
• Psychoanalysis (90845)
• Group Psychotherapy (90853)
 • Family Psychotherapy (90846, 90847)
• Crisis Intervention and Interactive Complexity (90839, 90840, 90785)
• Neurobehavioral Status Exam (96116, 96121)
• Psychological Evaluation (96130, 96131)
• Neuropsychological Evaluation (96132, 96133)
• Psychological and Neuropsychological Test Administration and Scoring (96136, 96137,
96138, 96139)
• Health Behavior Assessment (96156)
• Health Behavior Intervention, Individual (96158, 96159)
• Health Behavior Intervention, Group (96164, 96165)
• Health Behavior Intervention, Family with patient (96167, 96178)
• Behavioral Screening (96127)
• Screening, Brief Intervention, and Referral to Treatment (G0396, G0397)
(2) CPT Codes Allowed via Traditional Telehealth Only
• Developmental Screening and Testing (96110, 96112, 96113)
• Adaptive Behavior Assessment (97151, 97152, 0362T)
• Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373T)
(3) CPT Codes Added to the Telehealth List but as Non-Covered Services (not reimbursable
in Medicare)
• Psychophysiological therapy (90875)
• Health Behavior Intervention, Family without patient (96170, 96171)
2. Rates: The reimbursement rates are the same as in-person sessions.
3. Co-pays, co-insurance, deductibles, and GET: All co-pays, co-insurance, and deductibles
for telehealth visits should continue to be billed to patients as usual. Providers cannot collect
GET for Federal Plans, ever.
4. New Patients: New patients can be seen for a 90791 utilizing telehealth/telephone per
guidelines above (no audio-only sessions). No initial face-to-face visit is required.
5. Age Restrictions: There are no age-restrictions for use of telehealth.
6. OTHER Telephone-Only Services: As of 3/30/20, psychologists can bill for time spent on
audio-only telephones if a patient calls because they are experiencing mental health issues
or symptoms. During these calls, the psychologist engages in assessment of the problem
(not formal testing) and then provides an intervention service. These are the only services
that can be provided by audio-only telephones. To bill for assessment and management
services, psychologists would use the following codes [These are not a 1-to-1 replacement
for traditional psychotherapy by phone, APA is continuing to advocate for that.]:
• 98966 - Telephone assessment and management service provided by a qualified
nonphysician health care professional to an established patient, parent, or guardian not
originating from a related assessment and management service provided within the
previous 7 days nor leading to an assessment and management service or procedure
within the next 24 hours or soonest available appointment; 5-10 minutes of medical
discussion.
• 98967 - Telephone assessment and management service provided by a qualified
nonphysician health care professional to an established patient, parent, or guardian not
originating from a related assessment and management service provided within the
previous 7 days nor leading to an assessment and management service or procedure
within the next 24 hours or soonest available appointment; 11-20 minutes of medical
discussion.
• 98968 - Telephone assessment and management service provided by a qualified
nonphysician health care professional to an established patient, parent, or guardian not
originating from a related assessment and management service provided within the
previous 7 days nor leading to an assessment and management service or procedure
 within the next 24 hours or soonest available appointment; 21-30 minutes of medical
discussion.
Psychologists can also bill for brief communications (known as e-Visits) with established
Medicare patients. E-Visits involve a brief communication, typically initiated by the patient,
and can be furnished in any location or geographic area. Medicare co-insurance and
deductible amounts cannot be waived for e-Visits. To bill for an e-Visit, psychologists would
use the following codes:
• G2061: Qualified nonphysician healthcare professional online assessment and
management, for an established patient, for up to seven days, cumulative time
during the seven days: 5-10 minutes.
• G2062: cumulative time of 11-20 minutes during the seven days.
• G2063: cumulative time of 21 or more minutes during the seven days.

Tricare:
MH Telehealth Coverage:
https://www.tricare-
west.com/content/hnfs/home/tw/prov/benefits/benefits_a_to_z/telemedicine_services/telemedici
ne_details.html
https://www.tricare-west.com/content/hnfs/home/tw/prov/res/provider_news/telemedicine-
update-for-iop-and-substance-abuse-treatment.html
Billing: https://www.tricare-
west.com/content/hnfs/home/tw/prov/claims/billing_tips/telemedicine.html

OPTUM: Providers are responsible to provide telehealth services in accordance with OCR’s
Notice and may use:

• HIPAA-approved telehealth technologies

• The following platforms may be used during the current nationwide public health
emergency: Popular applications that allow for video chats — including Apple FaceTime,
Facebook Messenger video chat, Google Hangouts video, Zoom or Skype — may be
utilized to provide telehealth without risk that OCR might seek to impose a penalty for
noncompliance with the HIPAA rules related to the good faith provision of telehealth during
the COVID-19 nationwide public health emergency.
• Providers are encouraged to notify patients that these third-party applications potentially
introduce privacy risks, and providers should enable all available encryption and privacy
modes when using such applications.
• These platforms are NOT approved: Facebook Live, Twitch, Snapchat, TikTok, and
similar video communication applications are public facing, and should not be used in the
provision of telehealth to Optum Behavioral Health plan members by covered health care
providers
Until April 30, 2020, Optum Behavioral Health will reimburse appropriate claims
for outpatient telehealth services according to the following (also applies to Autism/Applied
Behavior Analysis):
• Commercial: For all Optum Behavioral Health commercial plans, any telehealth
services provided via a real-time audio and video communication system can be
billed for members at home or another location.
o Billing guidelines: Optum Behavioral Health will reimburse telehealth services
which use standard CPT codes and a modifier=GT or a POS=02 for both
 video-enabled virtual visits and telephonic sessions to indicate the visit was
conducted remotely.
• Medicaid: For all UHC Medicaid plans, any originating site requirements that may
apply under United Behavioral Health reimbursement policies are waived so that
telehealth services provided via a real-time audio and video communication
system can be billed for members at home or another location.
o Billing guidelines: UnitedHealthcare Community Plan will reimburse
telehealth services which use standard procedure codes such as CPT/HCPCS
codes and POS=02 or state Medicaid telehealth billing requirements if different
than using 02 for both video-enabled virtual visits and telephonic sessions to
indicate the visit was conducted remotely.
• Medicare Advantage: For all UHC Medicare Advantage and Medicare Part B
plans, including dual eligible special needs plans, any originating site requirements
that may apply under Original Medicare are waived.
o Billing guidelines: UHC will reimburse telehealth services which use standard
CPT codes and POS=02 for both video-enabled virtual visits and telephonic
sessions to indicate the visit was conducted remotely.