Like most things in the healthcare industry, there is a lot of confusion about the differences between mental and behavioral health. Who can provide services? How much does it cost? Can I use telehealth? What are these codes on my bill?

Rather than going down the rabbit healthcare hole yourself, we did it for you with the hopes that we can clear up a few misgivings and give you an idea about what you can expect when it comes to services and costs. Please note that this blog is focused on all things Tennessee, but if you are reading this from afar, you can use what we explore here as a map to locate similar information in your state. 

Let’s start by defining mental and behavioral health. Mental health tends to be associated with thoughts and emotions, while behavioral health is mostly associated with physical health and is often coupled with a medical diagnosis (American Psychological Association, 2022). Thousands of years of human history have taught us one thing: it is not healthy to separate one’s brain from one's body. So, the burning question is, why do we still try to do it in the delivery of care? If you have the answer, please let us know!

The good news is that in Tennessee, licensed professional counselors who have mental health service provider (LPC-MHSP) designation have the authority to deliver services to “prevent, diagnose, and treat mental, emotional or behavioral disorders and associated disorders which interfere with mental health” (Rules of the Tennessee Board for Professional Counselors, Marital and Family Therapists, and Clinical Pastoral Therapists, 2007). But here’s an important note. Tennessee has two counselor levels: LPC-MHSP and the licensed professional counselor (LPC). Both counseling levels have the same education requirements. But, to be an LPC-MHSP, you must pass a second licensing exam, whereas the LPC only has to pass one. Why are we telling you this? Because only those counselors who are LPC-MHSP have diagnostic authority. 

Okay, not to make things even more complicated, but once you have identified the right provider for you, you also need to know how the service is coded. You might have seen a current procedural terminology (CPT) code on a superbill or insurance claim. Simply put, this is a numeric code describing the service you received from the provider. Mental health codes start with a 90, and behavioral health codes with a 96.

The chart describes service fees for each code delivered in non-facilities, which is fancy language that just means services were delivered in “outpatient clinics, urgent care centers, home services” and not “provided within a hospital, ambulatory surgery center, or skilled nursing facility” (Welcome to Flash Code, n.d.). This is important because services delivered in a facility are priced differently than those delivered outside. 

Yes, this just gets more and more complicated. Thank you for staying with this blog post; the chart below can help bring it all together. But first, here are a couple of notes on the fees listed below. 

After an exhausting Google search for service rates in Tennessee and following several links to get to the numbers, we discovered that Tennessee uses Fair Health to publish its worker compensation standard fees. Tennessee Medicaid, Medicare, and other insurance provider fees for services were not discovered searching online. However, the Centers for Medicare and Medicaid Services did explicitly describe those behavioral health services that an LPC-MHSP can bill for, which are indicated below, in addition to the mental health service codes.

Also, per CMS.gov, behavioral health assessment and intervention services can be delivered online as long as the provider is available to work with you face-to-face (Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services, 2023). In other words, healthcare caught up with the rest of the world and recognized that providers can work from home just like many other professionals who sometimes come into the office. In the end, that just makes it easier to ensure you get the treatment you need if your provider cannot make it to the office that day. 

Where telehealth gets a bit complicated is how it is coded differently in mental health from behavioral health. If you receive counseling services online, you will likely see the code GT to indicate services were delivered online. Please check in with your insurance company to determine if they require any additional coding to note telehealth because some of them do. 

Okay, here are a few final details to share with you before we dive into the CPT codes. 

1. Your medical provider and behavioral health interventionist do not have to be in the same office or employed under the same umbrella (Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services, 2023). In other words, your providers can put you at the center of your care and collaboratively work together to ensure you get the right treatment right when you need it.

2. Some insurance companies do not allow same-day billing when services are delivered at the same address. For example, Medicare Part B recognizes the value of integrated behavioral health and pays for services delivered to you on the same day (Medicare Mental Health).

So there you have it—a complex, albeit complete description of mental and behavioral health and how they might show up differently on your superbill, invoice, or insurance claim, depending on where the services are being provided and which issues are targeted. To say we have a complicated medical system in the United States is an understatement. Hopefully, this blog post clears up any misconceptions that may have lingered between the two. 

If you are ready to get started with your mental health journey, go to the homepage, click the orange request appointment buttons, and choose the free 15-minute consultation to get started on your path to holistic health today! As a reminder, Indigo Path Collective is unable to accept insurance at this time. Still, our principal, Jeremy Henderson-Teelucksingh, is a Tenneese-based LPC-MHSP and is training to become a doctor of behavioral health, which means we work on those behavioral issues that are getting in your way as much as we do your mental health concerns…and per the numbers, it looks like we offer a great value to those who chose Indigo Path Collective. 

Please Note: If you are using insurance or Medicaid to pay for services, it is highly likely they will only pay if you are working with an LPC-MHSP. Check with your insurance provider or Medicaid representative for more information. Your insurance provider can inform you of any reimbursement you are eligible for under their plan. 

References

American Psychological Association. (2022, November). Health behavior assessment and intervention services. Https://www.apaservices.org. https://www.apaservices.org/practice/reimbursement/health-codes/health-behavior

Fair Health. (n.d.). Tennessee WC Fee Schedule. Retrieved September 24, 2024, from https://orders.fairhealth.org/

Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services. (2023, December 5). Cms.gov. https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/behavioral-health-integration-faqs.pdf

Health and behavior assessment/Intervention – Medical policy article. (2024, January 1). Cms.gov. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52434

Medicare Learning Network. (2021, October). Medicare Mental Health. Hhs.gov. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/medicare_mental_health.pdf

Rules of the Tennessee Board for Professional Counselors, Martial and Family Therapists, and Clinical Pastoral Therapists, Chapter 0450-01 General Rules Covering Professional Counselors 47 (2007). https://publications.tnsosfiles.com/rules/0450/0450-01.20200402.pdf

Top CPT codes for mental health billing – my clients plus. (n.d.). Myclientsplus.com. Retrieved September 24, 2024, from https://myclientsplus.com/top-cpt-codes-for-mental-health-billing/

Welcome to Flash Code. (n.d.). Flashcode.com. Retrieved September 24, 2024, from https://flashcode.com/faq_sq2.html