Behavioral Health- Telemedicine FAQ – Effective January 1, 2025

Washington State Health Care Authority sent this bulletin at 12/20/2024 02:51 PM PST

December 20, 2024

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Apple Health (Medicaid) Provider Alert

Attention providers

What is changing?

Effective for dates of service on and after January 1, 2025, the Health Care Authority (HCA) updated the telemedicine policy found on HCA’s Provider billing guides and fee schedules webpage under Telehealth. Updates include the following:

HCPCS code G2012 is being replaced with CPT® code 98016.

*Note: CPT® code 98016 is not applicable to behavioral health providers.

See HCA’s Apple Health (Medicaid) Behavioral Health Policy and Billing FAQ, effective January 1, 2025, for guidance related to the Service Encounter Reporting Instructions (SERI) guide, Mental Health Services Billing Guide, and Substance Use Disorder Billing Guide.

In addition to clerical edits, HCA made significant content updates clarifying language for the following:

What are the requirements for providing services via telemedicine to a Apple Health (Medicaid) client in Washington State?
Can I bill and/or submit encounters for behavioral health services via telemedicine or telehealth for a Washington State Apple Health (Medicaid) client who may be temporarily located out of Washington State?

Program-specific telemedicine/telehealth information will be in specific HCA billing guides located on the Provider billing guides and fee schedules webpage.

Email HCA’s Apple Health clinical policy team for any questions related to HCA’s telemedicine policy.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Behavioral Health- Telemedicine FAQ – Effective January 1, 2025

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination