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ADHD and Telehealth: How to Bill and Code ICD-10 for Virtual ADHD Therapy

Michael Reider

Mar 5, 2025

ADHD affects approximately 6.1 million children in the United States and remains the most common childhood neurobehavioral disorder. Healthcare providers must understand the ICD-10 code for ADHD (F90) and its subtypes to document and bill treatment properly.

The recent move to telehealth services has substantially changed billing practices, especially in mental health care. The Centers for Medicare & Medicaid Services now supports virtual ADHD therapy through expanded telehealth coverage and specific billing codes. On top of that, 6 in 10 children with ADHD have concurrent mental health conditions, which makes accurate coding vital for detailed care.

This piece will guide you through everything you need to know about billing and coding for virtual ADHD therapy. You'll learn proper ICD-10 code usage, telehealth-specific documentation requirements, insurance claims processing, billing modifiers, and ways to ensure proper reimbursement for your services.

Understanding ADHD Telehealth Billing Basics

Good coding and documentation are the foundations of successful telehealth ADHD treatment billing. A clear understanding of these basics will give a smooth reimbursement process and compliance with healthcare regulations.

What is the ICD-10 code for ADHD

The ICD-10 code F90 stands for Attention Deficit Hyperactivity Disorder. This code has five specific subtypes that help document the condition accurately [1]:

F90.0: Predominantly inattentive type
F90.1: Predominantly hyperactive type
F90.2: Combined type
F90.8: Other type
F90.9: Unspecified type

You must document evidence of symptoms in two or more settings when picking the right code. The current severity should be specified as mild, moderate, or severe [2].

Key differences between in-person and telehealth billing

Telehealth billing is different from traditional in-person visits in several vital ways. The place of service (POS) codes change based on insurance requirements. Some insurance companies need POS code 02 for telehealth services. Others require POS code 11 with a 95 modifier [3].

Medicare policies now support permanent coverage for many mental health services through telehealth. These services include psychological diagnostic evaluations and psychotherapy sessions [4]. The CPT codes stay the same as in-person visits. The virtual delivery method needs proper documentation.

Required documentation for virtual ADHD sessions

Virtual ADHD sessions need specific documentation elements to back up insurance claims. Your clinical notes should have:

Date and time of the visit
Mode of communication (audio/video or audio-only)
Client and provider locations
Patient's consent for telehealth services
Start and stop times for timed services
Specific services provided and relevant clinical notes

CMS allows verbal consent during public health emergencies. Written consent is still better. All consent documentation should be in the patient's record [6].

Complete records must show why virtual care is medically necessary for ongoing ADHD treatment. This means documenting medication management, therapeutic interventions, and progress tracking. Prescribing stimulant medications through telehealth needs extra documentation. You should include detailed treatment plans and regular checks of how well the medication works [7].

Check insurance coverage before the first telehealth session to get clean claims and quick reimbursement. Each insurance provider might have their own rules for telehealth billing. Looking at their published guidelines helps avoid claim denials [3].

Setting Up Your Virtual ADHD Practice

Building a successful virtual ADHD practice demands meticulous attention to technical setup and patient onboarding. A solid foundation will give a smooth operation that meets healthcare regulations.

Technology requirements and HIPAA compliance

Your secure virtual practice begins with HIPAA-compliant technology choices. The practice needs dependable high-speed internet and video-enabled devices with webcams, speakers, and microphones [8]. Every telehealth service must meet HIPAA rules, which include:

Technology vendors must sign HIPAA business associate agreements
Patient data needs password protection and encryption
Patient interactions require secure communication channels [9]

Patient care excellence requires clear policies about communication boundaries, response times, and appropriate content sharing across platforms. Clinical support staff are a great way to get help with testing and coverage systems [10].

Creating telehealth-friendly intake processes

Patient experience and efficiency improve with simplified intake procedures designed for virtual care. Your first step should verify patient access to needed technology and their ability to use it. Quick training sessions help patients learn video platform basics [11].

Productive sessions need these vital intake elements:

Pre-assessment calls spot potential technical issues early
Remote testing setup guides walk patients through each step
Voice, text, and video instructions help create ideal testing spaces [10]

Complete care documentation requires these intake assessments:

Detailed bio-psycho-social history
Mental status examination
Risk assessment
Clinical treatment planning [12]

Research shows over 90% of patients prefer telehealth options for their original intake appointments [13]. This preference means your intake process should account for typical no-show rates while protecting valuable provider time slots.

Your protocols should address special situations like:

Private space arrangements for confidential talks
Technical disruption management during sessions
Care coordination for patients who struggle with communication [11]

Step-by-Step Billing Process

A systematic approach to billing virtual ADHD therapy ensures proper reimbursement. A well-laid-out process helps minimize claim denials and makes payment collection easier.

Insurance verification workflow

Call the insurance provider's customer service to verify coverage. Ask them about:

Telehealth service approval status
Required modifiers (95 or GT)
Claims submission details including payer ID
Authorization requirements
Reference number for the verification call [14]

Selecting appropriate CPT codes

These approved CPT codes work for virtual ADHD sessions:

90791 & 90792 - Diagnostic Interview
90832 - 30-minute psychotherapy
90834 - 45-minute psychotherapy
90837 - 55+ minute psychotherapy [15]

Legacy telehealth codes (98968, 99443) exist, but experts strongly advise against using them. Standard mental health procedure codes with appropriate modifiers work better [15].

Adding telehealth modifiers

Your insurance provider's requirements determine the modifier selection:

Modifier 95: Used for up-to-the-minute interactive audio and video telecommunications
Modifier GT: Legacy code that serves the same purpose as modifier 95
Place of Service (POS) code 02: Required by some insurers for telehealth services

Submitting clean claims

The payment process moves faster when you:

Make sure your documentation has:

Session date and time
Communication mode (audio/video)
Patient consent
Provider and patient locations
Service start/stop times [16]

Review these elements carefully:

Correct CPT codes with appropriate modifiers
Accurate diagnosis codes
Complete patient information
Proper documentation supporting medical necessity [17]

Note that downcoding (including fewer services than provided) leads to reduced payments, while upcoding can trigger audits and panel removal [18]. Accurate coding practices protect both your reimbursement and professional standing.

Common Billing Challenges and Solutions

Virtual ADHD treatment providers must overcome unique billing challenges that need smart solutions. A clear grasp of these obstacles helps make reimbursement smoother and keeps practice revenue stable.

Handling denied claims

Documentation gaps and coding errors lead to most insurance denials. Claims get rejected mainly due to:

Forms with errors or missing documentation [19]
Telehealth modifiers missing or wrong place of service codes [20]
Medical necessity not properly documented [19]

The explanation of benefits needs careful review after a denial. These steps can help resolve the issue:

File an internal appeal with supporting clinical documentation
Submit additional physician letters explaining medical necessity
Request external review through third-party assessment [19]

Studies show patients cut back their telemental health visits by 1.5 visits when they face out-of-pocket costs [21]. Proper claim submission becomes vital to ensure continuous care.

Prior authorization issues

Insurance providers have widely different prior authorization requirements. 27 state Medicaid programs now require prior authorization for ADHD medications prescribed to children and adolescents [22].

Authorization usually depends on:

ADHD diagnosis documentation (23 states require this) [22]
Alternative causes ruled out for symptoms
Proof that symptoms persist
Social environment impairment shown [22]

States enforce their own age restrictions. Minnesota won't cover ADHD medication for children under 3, while Texas sets different age limits based on medication type [22].

These steps help reduce authorization delays:

Check payer contracts for covered ADHD services
Document how long symptoms last and their effects
Start with non-medication treatments if insurers require it
Keep close track of authorization deadlines [1]

Change might be coming soon. A bipartisan bill introduced in Congress would make Medicare Advantage plans use electronic prior authorization programs by 2027, which could make approvals much faster [23].

Conclusion

Your success with virtual ADHD therapy billing relies on accurate coding, proper documentation, and following telehealth regulations. Insurance requirements might look complex, but knowing the basics of ICD-10 codes, telehealth modifiers, and documentation standards will make your billing process smoother.

Clean claims need good preparation. Check insurance coverage before sessions, keep detailed clinical notes, and make sure your technology meets HIPAA requirements. It also helps to stay up-to-date with state-specific prior authorization rules to avoid delays in getting paid.

Billing issues can pop up, but you can resolve them through proper appeals and by following payer requirements carefully. Your success rates will improve by a lot when you combine accurate diagnostic coding with complete documentation that shows medical necessity.

The best part is that becoming skilled at these billing practices lets you focus on what truly counts - delivering quality care to your ADHD patients through available virtual services. Your practice will thrive as telehealth grows when you stay informed about coding updates and keep your billing systems well-organized.

FAQs

What is the ICD-10 code for ADHD?

The primary ICD-10 code for Attention Deficit Hyperactivity Disorder is F90. There are five subtypes: F90.0 (predominantly inattentive), F90.1 (predominantly hyperactive), F90.2 (combined type), F90.8 (other type), and F90.9 (unspecified type).

How does billing for virtual ADHD therapy differ from in-person sessions?

Virtual ADHD therapy billing requires specific place of service (POS) codes and modifiers. Some insurers require POS code 02 for telehealth, while others mandate POS code 11 with a 95 modifier. Additionally, documentation must include details about the virtual delivery method.

What documentation is required for virtual ADHD sessions?

Essential documentation for virtual ADHD sessions includes the date and time of the visit, mode of communication, client and provider locations, patient consent for telehealth services, start and stop times for timed services, and specific services provided with relevant clinical notes.

What technology is needed for HIPAA-compliant virtual ADHD therapy?

HIPAA-compliant virtual ADHD therapy requires reliable high-speed internet, video-enabled devices with webcams, speakers, and microphones. Additionally, providers must use technology vendors that sign HIPAA business associate agreements and implement password protection and encryption for patient data.

How can providers handle denied claims for virtual ADHD therapy?

To handle denied claims, providers should first review the explanation of benefits carefully. They can then file an internal appeal with supporting clinical documentation, submit additional physician letters explaining medical necessity, or request an external review through third-party assessment if needed.