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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicySendero Telehealth Therapy Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentSendero Health PlansPolicy N/A

    Billing for Telehealth Therapy Services during the COVID-19 Response

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    This policy governs reimbursement and billing requirements for specified in-network telehealth therapy services provided to Sendero Health Plans Members during the COVID-19 response. It addresses eligible therapy categories, authorization requirements, permitted modalities, place-of-service reporting, and excluded services.

    Policy Summary
    PayerSendero Health Plans
    PolicyBilling for Telehealth Therapy Services during the COVID-19 Response
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionReport place of service 02 for telehealth delivery; existing authorizations do not need to be updated solely for the place-of-service code.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    POS 02Required telehealth place-of-service code
    7Behavioral health service categories eligible for telehealth
    3

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    Therapy domains covered
    AudiovisualRequired modality for most covered therapy
    Under 13Adult caregiver consent threshold

    Eligible Telehealth Therapy Services

    Home health, speech, occupational, and physical therapy

    Covered when all applicable authorization, modality, consent, and billing requirements are met:

    ALL of the following

    • ALL of the following

      • For outpatient physical, occupational, and speech therapy, the Member is established and has an existing approved prior authorization for dates of service beginning 7/27/2020.
      • For home health services, an existing approved prior authorization is on file for dates of service beginning 3/1/2020.
    • The service uses an interactive audiovisual connection to the Member.

    • For Members under age 13, one of the following applies

      • Informed consent is obtained from the Member's adult caregiver.
      • A designated health professional participates during the entire telehealth session.
    • Place of service (POS) 02 is reported to indicate telehealth service delivery.
    • Telephone-only telehealth services and services delivered via live chat are not covered.
    • Telehealth speech therapy and occupational therapy services for swallowing disorders are not covered.

    Behavioral health services

    Covered when all of the following are met:

    ALL of the following

    • The service is one of the following eligible behavioral health services

      • Intensive outpatient treatment (H0015, S9480).
      • Psychiatric diagnostic evaluation (90791, 90792).
      • Psychotherapy (90832, 90834, 90837, 90846, 90847, 90853, 90785, 90833).
      • Peer specialist services (H0038).
      • Screening, brief intervention, and referral to treatment (H0049, G2011, 99408).

    Applied behavior analysis therapy

    Covered when all of the following are met:

    ALL of the following

    • The Member is established and is receiving ABA therapy with an existing approved prior authorization on file.
    • The service uses an interactive audiovisual connection to the Member.
    • Place of service (POS) 02 is reported to indicate telehealth service delivery.
    • Telephone-only ABA services and services delivered via live chat are not covered.
    • Initial ABA assessments are not covered as telehealth services and should be rescheduled.

    Telehealth Billing and Coding

    Covered Telehealth Place of Service CodeRevenueCovered
    02Place of service code required to indicate telehealth service delivery
    Covered Behavioral Health Telehealth Service CodesmixedCovered
    H0015Intensive outpatient treatment
    S9480Intensive outpatient treatment
    90791Psychiatric diagnostic evaluation
    90792Psychiatric diagnostic evaluation with medical services
    90832Psychotherapy
    90834Psychotherapy
    90837Psychotherapy
    90846Psychotherapy
    90847Psychotherapy
    90853Psychotherapy
    1–10 of 26
    1/3
    Telehealth Place of Service
    Required place of servicePOS 02
    PurposeIndicates telehealth service delivery
    Authorization updateExisting authorizations do not need to be updated solely for the place-of-service code
    Consent or Designated Professional Participation
    ApplicabilityMember under age 13
    Adult caregiver requirementObtain informed consent from the Member's adult caregiver
    Alternative

    Provider Billing and Delivery Requirements

    Prior Authorization

    Prior Authorization Required for Outpatient Therapy

    For dates of service on or after 7/27/2020, outpatient PT/OT/ST telehealth is limited to established Members with an existing approved prior authorization on file.

    Prior Authorization

    Prior Authorization Required for Home Health

    For dates of service on or after 3/1/2020, home health telehealth services are limited to existing authorizations with an approved prior authorization on file.

    Prior Authorization

    Prior Authorization Required for ABA

    ABA telehealth is limited to established Members with an existing approved prior authorization on file.

    Policy Summary
    PayerSendero Health Plans
    PolicyBilling for Telehealth Therapy Services during the COVID-19 Response
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionReport place of service 02 for telehealth delivery; existing authorizations do not need to be updated solely for the place-of-service code.
    SourceLink
    On This Page
    Eligible Telehealth Therapy ServicesTelehealth Billing and CodingProvider Billing and Delivery Requirements
    Substance use disorder services (H0001, H0004, H0005).
  1. Mental health rehabilitation services (H0034, H2011, H2012, H2014, H2017).
  2. Psychological or neuropsychological test administration (96138, 96139).

  3. The delivery modality is one of the following

    • Interactive audiovisual connection to the Member.
    • Telephone-only behavioral health telehealth.
  4. Place of service (POS) 02 is reported to indicate telehealth service delivery.
    5. A designated health professional must participate during the entire duration of each telehealth session
    Billing Rule

    Report Telehealth With POS 02

    Report telehealth services with place of service (POS) 02; services are reimbursed at the same rate as in-office services. Existing authorizations do not need to be updated solely because the POS code changes.

    Documentation Required

    Consent or Continuous Professional Participation Required

    For Members under age 13, providers must obtain informed consent from the Member's adult caregiver, or a designated healthcare professional must participate for the entire duration of each telehealth session.

    Denial Risk

    Initial ABA Assessments Not Eligible for Telehealth

    Initial ABA assessments are not covered telehealth services. Reschedule the initial assessment for a non-telehealth setting.

    Note

    Evaluate Higher Level of Care for Urgent Needs

    For new Members needing urgent ABA-related services, evaluate whether a higher level of care is more appropriate to address acute or imminent risk of harm to the Member or others.