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Behavioral health services are now permanently allowed to be delivered via telemedicine for Medicare beneficiaries, as authorized under Section 123 of the Consolidated Appropriations Act, 2021. This provision enables such services to be provided through real-time audio/visual communication or audio-only technology, even when the patient is at home and regardless of their geographic location within the U.S. or its territories. Both the patient and the provider must be physically located within the U.S. at the time of service.
For Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), applicable HCPCS codes must be used, along with modifier FQ for audio-only visits (modifier 93 may also be appropriate, subject to MAC guidance). Starting in 2025, audio-only visits for behavioral health medication management will be permitted when the patient chooses this option based on their comfort level and access to video technology, with flexibility granted for what qualifies as the “home,” including private locations such as a car.
Use of CPT and E/M Codes for Telehealth (Effective 2025)
CPT codes 99441–99443 (telephone E/M services) will be deleted. In their place, clinicians must report telehealth Evaluation and Management (E/M) services using codes 99202–99215, along with the appropriate modifier:
- Modifier 93 – for audio-only services
- Modifier FQ – for audio-only telehealth behavioral health services (MAC-specific guidance may apply)
Technology Requirements for Audio-Only Behavioral Telehealth
When behavioral health services are provided using audio-only technology, the practitioner must still have the capability to conduct the visit via real-time audio/visual technology. This ensures that the choice for audio-only is based on the patient’s preference or limitations, not the provider’s lack of infrastructure.
Initial Face-to-Face Requirement Before Telehealth Initiation
Before starting telehealth services, the following conditions apply:
- The patient must have had a face-to-face visit with the clinician within the previous 6 months
- This requirement does not apply to:
- Patients being treated for substance use disorders (SUD)
- Patients residing in geographically underserved areas
- Another clinician of the same specialty within the same medical group can conduct the face-to-face interaction
Annual In-Person Visit Requirement and Its Delay
Medicare policy includes an annual in-person visit requirement for patients receiving behavioral health services via telehealth. However:
- This requirement has been delayed until January 1, 2026, per the 2025 Physician Fee Schedule (PFS) Final Rule
- If the patient is not seen in person within 12 months, the reason must be documented in the medical record
- Acceptable exceptions include when an in-person visit would be inadvisable or impractical for the beneficiary
CMS-Approved Telehealth Services for 2025
The following behavioral health and related Evaluation and Management (E/M) services are included on the 2025 CMS Telehealth Services List. These services may be delivered via telehealth, including real-time audio/visual or audio-only formats, where permitted:
Psychiatric Diagnostic Evaluation
- 90791 – Psychiatric diagnostic evaluation (without medical services)
- 90792 – Psychiatric diagnostic evaluation (with medical services)
Psychotherapy
- 90832, 90833 – 30 minutes
- 90834, 90836 – 45 minutes
- 90837, 90838 – 60 minutes
Psychotherapy for Crisis
- 90839 – First 60 minutes
- 90840 – Each additional 30 minutes
Other Behavioral Health Services
- 90785 – Interactive complexity (add-on code)
- 90845 – Psychoanalysis
- 90846 – Family psychotherapy (without the patient present)
- 90847 – Family psychotherapy (with the patient present)
- 90853 – Group psychotherapy
Evaluation and Management (E/M) Services
- 99202–99215 – Office/outpatient E/M visits (commonly used for medication management)
Inpatient and Observation Services
- Initial and subsequent inpatient visits
- Hospital discharge services
- Observation care visits
Telemedicine Guidelines for Behavioral Health – Private/Commercial Payers
During the COVID-19 public health emergency, most commercial (private) payers expanded coverage to include psychotherapy and other behavioral health services via telehealth. Many of these policies have remained in place post-pandemic, but unlike Medicare, commercial coverage varies by payer. Practices must always review individual payer policies for updates and billing compliance.
Place of Service (POS) Codes for Telehealth
When billing behavioral health telemedicine to commercial payers, the correct Place of Service (POS) code is essential:
- POS 02 – Telehealth provided outside the patient’s home
- POS 10 – Telehealth provided in the patient’s home
Common Modifiers for Telehealth (Commercial Payers)
Use the appropriate modifier depending on the type of technology used:
- Modifier 93 – Audio-only, real-time telemedicine
- Modifier 95 – Audio/visual, real-time telemedicine
- Modifier FQ – Audio-only telehealth services for behavioral health (some payers may require this)
Technology Requirement
Even when services are provided via audio-only, the clinician must still be technically capable of engaging in audiovisual communication. Audio-only may be used only if the patient:
- Is not capable of using video technology; or
- Does not consent to using it
Licensure Note
This guidance does not address cross-state licensure requirements. Clinicians must consult state boards or legal counsel to ensure compliance when treating patients across state lines.
Why Choose MindCare for Behavioral Health Telemedicine Billing?
As telehealth becomes a permanent part of behavioral health care, accurate billing has never been more critical. With shifting guidelines, evolving CMS rules, and payer-specific policies, psychotherapy service providers need more than just a billing company; they need a specialized partner.
MindCare offers end-to-end billing solutions explicitly tailored for mental and behavioral health practices. Our team is trained in the latest telehealth billing protocols, including correct use of POS codes, modifiers (FQ, 93, 95), and documentation standards. Whether services are delivered via audio-only or video, we ensure full compliance and optimized reimbursement.
Partnering with MindCare means fewer billing errors, faster payments, and confidence that your practice is aligned with the latest regulatory changes. Let us handle the complexity so you can stay focused on delivering exceptional care.