Despite having a relatively large number of hospital beds and providers compared to the rest of the U.S., Pennsylvania struggles to meet the mental health needs of its population. A recent study reports, “…Pennsylvania has 68 full-time equivalent mental health providers in designated shortage areas. In order to address the shortage issue, 44 more full-time providers are needed in these areas…”.

In light of the nationwide shortage of psychiatric providers, telepsychiatry has emerged as one solution to lack of access to mental health care as it allows patients to see providers remotely over secure video-conferencing technology.

GENOA HEALTHCARE TELEPSYCHIATRY IN PENNSYLVANIA

Q CODES & CPT CODES

Each telepsychiatry session generates two billable codes:

• The standard CPT codes for outpatient, psychiatric services.
• An originating site known as Q3014. The originating site fee is a Telemedicine Bonus that allows clinics to receive reimbursement for the use of the facility where telehealth services are rendered.

GETTING STARTED

The state of Pennsylvania requires clinics to obtain approval from the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS). Clinics in Pennsylvania are required to obtain a letter of support from both their county and their Managed Care Organization (MCO) before submitting the state’s waiver, referred to as Bulletin 14-01.

Psychiatrists: Any psychiatric provider with a state license in Pennsylvania can provide care via telepsychiatry.

APRNs: APRNs are currently not permitted to practice telemedicine in Pennsylvania.

How does reimbursement work for telepsychiatry?

Medicare & Medicaid

Pennsylvania has no parity, thus payors are able to reimburse at the rate in which they choose. Each Managed Care Organization (MCO) is different and offers an enhanced rate, which may or may not include the originating site fee or Q3014 code.

FQHCs

FQHCs may bill for telemedicine, however, they may not bill the Q3014 code because they receive an encounter rate.

What tech does my clinic need?

Setting up telepsychiatry at your clinic is simple. The set up will require:

• A large monitor screen
• A two-way video telecommunication system that allows for real-time communication between the provider and patient
• HIPAA-compliant video conferencing technology