Welcome back to part 4 of telebehavioral health billing and reimbursement. I'm Carol Yarbrough, your host. Let us proceed. I have some new, not telehealth, using virtual modalities codes to share with you. 

OK. Telephone call, not telehealth. You're thinking, wait a minute. You just told me the telephone calls are paid by CMS but a 93 modifier. Guess what. This HCPCS code, this G0544, not on the telehealth list. 

It's a specific telephonic follow up contacts performed in conjunction with a discharge from the ED. It's not on the list. Ergo, it is not a Medicare telehealth service. But guess what, they're paying for it. 

It's a Communication Technology Based Service, otherwise known as CTBS. We love our acronyms in every business sector, more so with health. The billing practitioner has to actually talk to the patient. 

So this means if you're an NPP billing in the Ed, who else gets to be bill in the ED, an MD, or a DO, or an NPP? You have to make the time. This is so cool. 

Get to-- it, says post-discharge follow up for behavioral per calendar month. I'm not sure how many units you can bill. I bet you, it covers the whole month. I bet you. It's also covering the entire time that you've tried to reach the patient, and they don't pick up. 

But once that patient-- once you reach the patient on the phone and you get $61.78, if you're not at a facility, I guess you're at a freestanding emergency department. Could happen. There are freestanding EDs. 

Facility payment. You're at an emergency department that is on the same footpath-- footprint as a hospital. That means you're at a facility, $47.87. It's great code. Check it out. 

Digital Mental Health Treatment. DMHT. I consistently want to type DHMT. I don't know why. If there is that mistake somewhere in this deck because my subconscious has taken over. This is modeled on coding for remote therapeutic monitoring services, and it only applies modeled, but it only applies to an FDA cleared device. 

Recall, remote physiological monitoring. You must use a device that is defined as a device by the FDA. Blood pressure monitor is defined as a device. A tongue depressor is the example that the FDA gives. It's a device. It does what it's supposed to do. 

RTM, Remote Therapeutic Monitoring. You're using software as medical device. It has not necessarily been cleared, though many are. Rearranged motion, therapy. There's also cognitive behavioral therapy. 

You log in to a medication, prescribed activity, prescribed for you by your LCSW, your psychologist, your MF, MT, marriage, family, behavioral health counseling, one of those people. Community health worker. Say, you're cleared in behavioral health. Many things to do. 

I don't think you prescribe this, but LCS said you can. You have to use an FDA-cleared therapy device. I don't know what this device is. I don't. 

I'm sure if you go out to ChatGPT and say, hey, can you tell me what medical clear device by the-- FDA clear device by the FDA would qualify for G0552? Now, it's the same thing. 

So get your device supply, and someone's going to train you how to use it. I keep on saying you interchangeably. You're the patient, you're the provider, whoever you are. Now, the contractor's pricing this one. 

Because maybe-- I don't know, maybe in Washington State, there's a company that uses an FDA-cleared device that's only being billed to Noridian. So what's going to happen is they're going to price that device for you. 

You're going to give them your receipts. This is how much it's costing me every month to pay for the subscription so my patients can be treated and happy, and they're going to be happy. They're going to be treated in between the time I have. 

Their next patients-- my next visit is scheduled for. They're going to get consistent therapy throughout the month until my next appointment, throughout the week, throughout the next two days. Constantly, you can have a digital device, provide reminders, treatment, interventions. 

It's not taking the place of a person. It's reinforcement. So unlike RPM and RTM, there's no code for a monthly reimbursement. So I hope that contractor price first code gets priced pretty high. 

The G0553, at a facility, 20 minutes. At least 20 minutes. Not a portion thereof. At least 20 minutes. You get $30. If you are at place of service 11, which is a non-facility or practicing from your home or a non-facility, $51.75. 

And then if you reach a complete additional 20 minutes, you get to tag on the G0554 code as well and get additional reimbursement. Something to consider for you vendors out there, you innovative thinkers. OK. 

Definition. In conjunction with ongoing behavioral health treatment, you can't say like, here, take this. It's great seeing you take this. See you in a year. No, no, you gotta be-- gotta be monitoring what's going on. 

And it has to be demonstrable-- there has to be a demonstrable positive therapeutic impact. Now, you can't take say, like maybe you engage in the service of A90834 with a patient. At the same time you're reviewing the data, you don't get to double dip. 

Don't use the same time that you used to see the patient face to face or ear to face. Don't use that for this. And only bill for it if it's helping, it says. Who's the judge of that? How long does it take to help? 

OK, there are new econsult codes. These, I love econsult. I wish it was solved that we could go from in between institutions. But these are pretty cool. Say you're in a health system. University of Washington medicine facility, and you are a primary care physician. 

You're like, I want to refer this patient over for this very specific question I have about behavioral health. Do you know what, I can't get them an appointment for six months. They're so backed up. If you have amenable providers in your health system or in your contract area, who are willing to answer e-consults, this is an electronic consult code, it's provider to provider. It's not provider, prover-patient, to provider. 

Now, some of these are written only. Some of them require audio and written or face to face conversation written. There's got to be a written report somewhere in there somewhere. And there has to be a written request. 

It's like a consult. Remember the consult codes in the olden days, where an order goes in and you're like, ah, I must go. I've gotten this order, and this request for consult. I am going to document who the counsel came from, what the question was, and what my answer is. 

That's what you're going to do for these. And what is so cool is you can be a psychologist, CSW, MFT, there's an acronym, and a mental health counselor. You don't have to be an MD or an MPP, which is what the other official e-consult codes require. 

This is beautiful. I don't know why. Just a minute for-- a minute for everyone. I want everyone to be able to do everything. And what I love about these is, yeah, you don't have time in your schedule to see the patient. But if it makes sense to answer in 5 to 10 minutes, written and telephone, if it makes sense, unless you're like, no, no, no, this patient has to come into clinic. 

Sorry. Wait, they're coming in right away. If it makes sense to do this, you exchange this information electronically and verbally, get paid, paid by the minute. It's not whether or not, it's more severe or not. 

I guess depending on severity, it might take you longer to answer it because you want to be more concise and clear. Anyway, 11 to 20 minutes get $34.61. G0548, 21, 30 minutes. That's up another $20, $18, and then 31 or more minutes. 

Medical consultative discussion and review. But really it's behavioral health consultative discussion review. See how they copied that, and it doesn't really translate to behavioral health? And then if it's just written, just written. 

Put the time in your notes too. It's like any other behavioral health. Put the time in. I spent five minutes or more providing this written report, at least five minutes. This took me at least five minutes or say I spent 20 minutes on this. 

Didn't have time for a phone call. Just give me $32 for that, will you? Took you over 30 minutes. Goes up $1. Nice. But again, so cool. No more curbside consults. 

Just say no. Say, hey. Medicare, primary care provider, I am a Medicare-enrolled behavioral health provider. Send me that consult in writing, and make it specific and clear about what you want, and I'm going to answer that medical advice question to you, the provider. 

And the PCP or the requesting provider does have to consent the patient like, hey, you're going to get a bill from a psychologist. You're not going to get the full bill. You're going to get your co-pay request or a deductible, or whatever your Medicare 20% is.