Currentblue cross blue shield - michiganPolicy N/A

Telehealth for behavioral health providers (PDF)

Defines telehealth coverage, billing, prior authorization, technology, eligible providers, covered procedure codes, facility and professional billing rules for behavioral health visits across Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members (Revised February 2026).

Policy Summary

Payerblue cross blue shield - michigan

PolicyTelehealth for behavioral health providers (PDF)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDocument clinical progress and justification for telehealth and include modality used; verify prior authorization requirements via the Summary of utilization management programs for Michigan providers.

SourceLink

POLICY UPDATE CHANGES

No material changes — has_material_change = false

~30+Listed billable behavioral health CPT/HCPCS codes

3IOP/PHP revenue codes specified

1Vendor-specific Teladoc billing note

Coverage Summary

This policy provides behavioral-health–specific telehealth guidance for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage payers. It outlines coverage, billing, prior authorization, technology, eligible providers and facility rules for behavioral health telehealth services. Revised February 2026.

Telehealth Coverage Criteria

General Telehealth Coverage Criteria

Covered when ALL of the following are met:

Service is a behavioral health service (psychotherapy, assessments, medical treatments, ABA where applicable) that can be delivered via telehealth per policy guidance

Service is within provider's scope of practice and licensure for the state where the patient is located

Providers must be licensed, registered, or otherwise authorized to perform services in the state where the patient is located.

Clinical documentation supports the procedure code billed and demonstrates significant progress toward treatment goals when billing telemedicine procedure codes

Procedure codes should be billed for telemedicine only if provider documents significant progress to established treatment goals.

For Medicare Plus Blue and BCN Advantage members: procedures allowed via telehealth are subject to CMS List of Telehealth Services guidance

Follow CMS guidance for Medicare Advantage plans.

Prior authorization requirements (if any) applicable to the service are met

Prior authorization requirements apply equally to in-person and telehealth services; see Summary of utilization management programs for Michigan providers.

Telephone-only vs Audiovisual

Coverage distinctions:

Either: Audiovisual telemedicine visits are covered and preferred when possible because they allow risk assessment and symptom observation

Providers are expected to use audiovisual technologies whenever possible because visual technology enables risk assessment and identification of signs not otherwise apparent.

Either: Telephone-only visits are covered for all behavioral health services for which telemedicine is payable for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members

Telephone-only visits use the telephone to provide real-time clinical health care services when audiovisual technology isn't available.

Autism (ABA) Telehealth Criteria

ABA services payable via synchronous telemedicine when appropriateness criteria met:

Assessment (code *97151) via live interaction is payable

This assessment includes live interaction with the member and is critical to evaluation.

Applied Behavior Analysis (code *97153) is allowed via telehealth for members who meet appropriateness criteria

Refer to Guidelines for autism interventions delivered via telemedicine to determine appropriateness.

Skills training (*97154), protocol modification (*97155), caregiver training (*97156), multi-family caregiver training (*97157), and intensive skills training (*97158) are payable via synchronous telehealth as specified

Protocol modification (*97155) can be provided up to 100% via telehealth.

HCPCS S-codes S5108 (LBA supervision) and S5111 (caregiver training) are payable only to Michigan providers delivering services to out-of-state members who cannot use AMA Category I codes

S5108 and S5111 payable only to Michigan providers in the out-of-state context.

IOP and PHP via Telemedicine

Facility-level partial hospitalization and intensive outpatient services:

IOP and PHP services for mental health and substance use disorders are payable via telemedicine (audiovisual or telephone) to contracted facility providers when contract allows

Facilities can provide IOP and PHP to BCN commercial and BCN Advantage members only when contracts specifically include these services; for Medicare Advantage follow CMS guidance.

For Blue Cross commercial: IOP services for substance use disorders must be delivered by a substance use treatment facility

Check member eligibility and benefits prior to providing services.

Facilities must bill specific revenue and procedure codes to indicate telemedicine delivery (see billing section)

For IOP bill revenue code 0905 (all BCN commercial and select Blue Cross commercial members) or 0906; for PHP bill revenue code 0912 and include applicable procedure codes (Blue Cross) or S0201 (BCN). Include GT/95 modifier and licensure modifier for BCN as required.

Covered and Billing Codes

Outpatient psychotherapy and psychiatry codes covered via telehealth (audiovisual or telephone-only)CPTCovered

90785	Interactive complexity
90791	Psychiatric diagnostic evaluation (no medical services)
90792	Psychiatric diagnostic evaluation with medical services
90832	Psychotherapy, 30 minutes
90833	Psychotherapy, 30-minute add-on (behavioral health medical providers only)
90834	Psychotherapy, 45 minutes
90836	Psychotherapy, 45-minute add-on (behavioral health medical providers only)
90837	Psychotherapy, 60 minutes
90838	Psychotherapy, 60-minute add-on (behavioral health medical providers only)
90839	Psychotherapy for crisis, first 60 minutes

1–10 of 15

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Telephone and online assessment/management codes (physicians) - Blue Cross & BCN commercialCPTCovered

98008	By telephone (physician list)
98009
98010
98011
98012
98013
98014
98015
98000	Online (physician list)
98001

1–10 of 20

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Telephone and online assessment/management codes (qualified non-physician)CPTCovered

98966	Telephone E/M by qualified non-physician
98967
98968
98970	Online digital E/M by non-physician
98971
98972

Routine online "check-in" visit codes (Blue Cross & BCN commercial)CPTCovered

99421	Online E/M (physician)
99422
99423
98970	Online E/M (non-physician)
98971
98972

Telemedicine vendor (Teladoc Health) billable codesCPTCovered

90791
90792
90834
98005

Autism / ABA codes payable via telehealth (synchronous)CPT|HCPCSCovered

97151	Assessment
97153	Applied behavior analysis (ABA)
97154	Skills training by behavior technician (group)
97155	Protocol modification
97156	Caregiver training
97157	Multi-family caregiver training
97158	Skills training (more intensive) by LBA in group
S5108	LBA supervision of technician (payable only to Michigan providers for out-of-state members)
S5111	Caregiver training (payable only to Michigan providers for out-of-state members)

RHC/FQHC distant site telehealth codeHCPCSCovered

G2025

Distant site for telehealth in RHC/FQHC (Blue Cross commercial: bill on CMS-1500)

IOP/PHP facility revenue and procedure codesmixedCovered

0905	Revenue code for IOP via telemedicine (all BCN commercial and select Blue Cross commercial members)
0906	Alternate revenue code
Q3014	Telehealth origin code (dates of service on or before 2021-09-30)
0912	Revenue code for PHP via telemedicine
S0201	Procedure code for PHP services for BCN commercial

Procedure codes that do NOT require GT or 95 modifier (Blue Cross commercial OPC exceptions)CPT

98000
98001
98002
98003
98004
98005
98006
98007
98970
98971

1–10 of 11

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Procedure codes that do NOT require GT or 95 modifier for telephone-only OPC facility claimsCPT

98966
98967
98968
98008
98009
98010
98011
98012
98013
98014

1–10 of 12

1/2

Actions for Providers (Authorization, Documentation, Billing)

Documentation Required

Document clinical progress and justification for telehealth

Clinical documentation must support the procedure codes billed for telemedicine-delivered services, demonstrate significant progress toward established treatment goals, and indicate the modality used (audiovisual or telephone).

Prior Authorization

Check prior authorization requirements

Determine whether the specific service requires prior authorization by checking the Summary of utilization management programs for Michigan providers; prior authorization requirements apply equally to in-person and telehealth services.

Billing Rule

Use correct modifiers and place of service

For audiovisual telemedicine visits include the GT or 95 modifier when billing procedure codes except the listed exceptions; use place of service 10 when the patient is at home and 02 when the patient is in another location. For professional claims, follow the modifier and place-of-service guidance and include the rendering provider licensure modifier first for OPC claims.

Billing Rule

OPC facility modifier ordering and exceptions

For OPC facility telemedicine claims list the rendering provider licensure-level modifier first (examples AH, AJ, HO), then the telemedicine modifier (GT or 95). Exceptions exist where GT/95 are not required for specified procedure codes; follow the policy tables for the exact code exceptions.

Billing Rule

IOP/PHP facility billing requirements

To indicate IOP or PHP services were provided via telemedicine, bill the approved revenue codes and include the applicable procedure code and telemedicine modifier; BCN claims must include the licensure-level modifier where required and use the specified type-of-bill for substance use disorder claims.

0905
0906
0912
Q3014
S0201

Billing Rule

RHC/FQHC distant site billing

For distant-site telehealth services provided in an RHC or FQHC, bill HCPCS code G2025 on a CMS-1500 professional claim for Blue Cross commercial members; BCN commercial billing follows the contracted agreement.

G2025

Documentation Required

Licensure/state location requirement

Providers must be licensed, registered, or otherwise authorized to perform the service in the state where the patient is located, and services must be within the provider's scope of practice.

Background and Definitions

This policy serves as behavioral-health–specific telehealth guidance that complements the broader Telemedicine Services Medical Policy and references CMS telehealth guidance for Medicare Advantage populations. It defines which psychotherapy, assessment, ABA and facility IOP/PHP services may be delivered via audiovisual or telephone-only telehealth, and includes billing and documentation requirements.

The policy applies across Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members but notes plan-specific differences: for Medicare Plus Blue and BCN Advantage follow the CMS List of Telehealth Services and CMS billing guidance, BCN Advantage recognizes OPC facilities while Medicare Plus Blue does not, and certain facility billing and revenue code requirements vary by Blue Cross versus BCN commercial contracts.

Term	Definition
Telehealth
Umbrella term including audiovisual, telephone-only and asynchronous visits providing synchronous real-time clinical care; asynchronous behavioral health generally not payable except specified codes (96130, 96156).
OPC
Outpatient psychiatric care facility

Name	Type	Notes
CMS List of Telehealth Services
NCD
For Medicare Plus Blue and BCN Advantage members: to determine which procedures can be performed via telehealth, see the List of Telehealth Services webpage on the cms.gov website; follow CMS guidance when billing telehealth visits.

OpenPayer

Telehealth for behavioral health providers (PDF)

Coverage Summary

Telehealth Coverage Criteria

Covered and Billing Codes

Actions for Providers (Authorization, Documentation, Billing)

Background and Definitions

Medicare Determinations

Revision History