Archived — retained for historical context. Verify current payer requirements before acting.
How is this indicated on the claim form?
S9480 is the Healthcare Common Procedure Coding System (HCPCS) code for intensive outpatient psychiatric services, billed per diem — it is the IOP per-diem code, not a telehealth code. Telehealth delivery is not indicated by S9480 itself; it is reported separately with a modifier and place-of-service code (see below). Whether or not insurance allows reimbursement for S9480 delivered via telehealth will depend on the specific insurance plan and policy.
To indicate that the service was provided via telehealth on the claim form, you need to use the appropriate modifier and place of service (POS) code. Current guidance is to append modifier 95 to the procedure code (S9480) and report POS 02 (telehealth provided somewhere other than the patient’s home) or POS 10 (telehealth provided in the patient’s home). The GT modifier was used for this in the past but has largely been retired, so confirm each payer’s current telehealth requirements before submitting.
Not all insurance plans cover telehealth, and even those that do may have specific requirements or limitations. Check with the insurance provider or the policy documentation to verify coverage and any documentation or requirements needed for reimbursement.
H0001 and 90791 are two different procedure codes used in mental health services.
H0001 is a HCPCS code used for alcohol and/or drug assessment. It covers the assessment itself — evaluating a patient for a substance use disorder and determining the appropriate level of care — and does not cover ongoing treatment. Counseling is billed under separate codes (for example, H0004 for individual counseling and H0005 for group counseling), and case management is a separate service as well. H0001 is typically used in the context of substance abuse treatment programs, where the assessment establishes the basis for a treatment plan.
On the other hand, 90791 is a Current Procedural Terminology (CPT) code used for psychiatric diagnostic evaluation. This code is used to bill for initial psychiatric evaluations, where a clinician assesses a patient’s mental health condition, medical history, and related factors to arrive at a diagnosis and treatment plan. 90791 is typically used in the context of mental health treatment, where the focus is on addressing a wide range of mental health conditions.
In practice, you would bill H0001 when performing a substance use assessment, and 90791 when providing psychiatric diagnostic evaluation services for mental health conditions. The correct code depends on the specific services provided and the payer’s requirements, so confirm with the payer or a coding specialist before you submit.
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