Extending Skilled Intervention
Outside of the Therapy Session
Important tips and guidelines to help you successfully navigate claim reimbursement for TheraWe.
Please note: final coverage is determined by your state and insurance contracts.
The TheraWe platform can be used to recover lost revenue for supporting parents and monitoring child progress outside of the therapy session. Sending messages and videos over a HIPAA compliant service qualifies as asynchronous telemedicine and is often referred to as "store and forward" telehealth. The TheraWe platform provides the ability to work with families outside of the clinics and receive reporting on time and patients for telehealth and CPT billing. In addition, TheraWe will integrate into your practice management system to automate this process.
Therapist Usage and Billing Step-by-Step
Step 1: Setup and Authorize Patient Insurance
During patient intake and insurance setup, authorize codes and hours for the child based on diagnosis and coverage for extended intervention, parent training, remote monitoring, etc. See CPT Guidance.
Step 2: Create Content
In the therapy provider's normal workflow with parents in a therapy session, short training videos and notes are created for the home note. At the end of the session, all parents/caregivers associated with the child receive the session update and home program video clip instructions.
Step 3: Engage and Track
In the days or weeks between a session, caregivers practice the home program and provide video posts and questions back to their therapy team. When the therapy providers engage and provide back answers and additional content, this time is logged in reporting for billable time (with additional audit reporting available).
Insurance Billing Point 1: Remote and Asynchronous telehealth (see breakdown between Behavioral, Speech, Physical, and Occupational Therapy below)
Step 3: Monitor
Every five days between sessions, caregivers are prompted to complete a remote monitoring questionnaire about the child that is sent to the therapy team. After the therapy team reviews, this is logged in reporting for billable time.
Insurance Billing Point 2: Remote Monitoring (see the breakdown between Behavioral and Medical monitoring below)
Step 4: Repeat
Parents return to the clinic or schedule another home visit to repeat the process. Everyone wins!
Bill Point 1: Asynchronous Time Spent Working with Parents Questions/Videos
Recommendation: Use the extension of the CPT codes for the type of therapy being provided or parent consultation.
- Behavioral Health (ABA/BCBA): Assessment (97151, 90887); Treatment (97153- 97158); Parent Training (90887)
- Speech and Feeding: Evaluation for a speech-generating device (92607); Evaluation of auditory rehabilitation status (92626), Assessment of aphasia (96105), Standardized cognitive performance testing (96125); Cognitive skills development (G0515)
Sensory integration (97533)
- PT/OT: Therapeutic (one-on-one) procedures (CPT 97110–97546); Re-evaluations (97164, 97168)l Constant attendance (one-on-one) modalities (97032–97039); Therapeutic (one-on-one) procedures (97110–97546); Tests and measurements (97750–97755); Orthotic and prosthetic management (97760–97762)
Bill Point 2: Remote Monitoring
Recommendation: Use the appropriate code mapped to the mental or medical health model.
- Behavioral Health (ABA/BCBA): Care management services for behavioral health conditions (99484; $40-60 a patient a month)
- Medical (PT, OT, SLP): Remote monitoring (99457; $50 a patient a month)
With the constantly shifting state telehealth policy landscape, you’ll need to do a little research to figure out how Medicaid reimbursement will work for your practice. Click on the below map from the Center for Connected Health Policy to see how Medicaid telehealth reimbursement works in your state. You can also visit your state Medicaid agency for more information.
Each private payer does telemedicine reimbursement a little differently. The good news is that there are resources to help! We recommend you start with the grant-funded Heartland Telehealth Resource Center to get a consultation on how this fits for you.