Telehealth Mental Health Billing in Wisconsin
I have seen some of our behavioral health practices in Wisconsin that have embraced the telehealth sessions during the pandemic often generate MORE revenue through their virtual therapy sessions than in-office appointments. It is because they bill them correctly. Telehealth mental health billing operates with their own sets of rules than in-office therapy billing. And their reimbursement rates differ by payer. Prior authorization requirements differ from in-office services. Compliance rules are stricter. Due to these most practices are unknowingly leaving a significantly huge amount on the table because they're billing telehealth sessions incorrectly. For mental health practices specifically, the denial rate is much higher compared to the other telehealth claims. And this is because telehealth billing requires state-specific knowledge that generic medical billing systems don't capture. As a medical billing company with year of experience and specializing in behavioral health, we help practices across Wisconsin to overcome these challenges and optimize their telehealth billing processes for Wisconsin's unique requirements.
In this blog, I have outlined the complete Wisconsin mental health telehealth billing landscape with the exact modifiers and place of Service codes to be used, compliance requirements that are specific to Wisconsin and real-world documentation standards that would prevent denials. Whether you're billing psychotherapy codes, psychiatric evaluations or medication management, this guide walks through every step.
What is Mental Health Telehealth Billing?
The state of Wisconsin faces shortage in mental health professionals, particularly in rural and underserved communities. This workforce shortages, extensive waitlists and geographic barriers have limited the timely access to behavioral health services. According to the Wisconsin Department of Health Services, telehealth is becoming an increasingly important strategy for expanding access to mental health care across the state. Along with this the three major regulatory and market shifts that were announced recently have made telehealth services gain more popularity.
1. Increase in rate of reimbursements, effective January 1, 2026
ForwardHealth has increased their reimbursement rates for mental health services as authorized by 2025 Wisconsin biennial budget. This becomes effective for dates of service on and after January 1, 2026. This is significant as practices can now capture more revenue if they bill correctly.
2. Wisconsin Act 11 Made Telehealth Flexibilities Permanent
Many of the telehealth flexibilities that were temporarily allowed during the COVID-19 Public Health Emergency, have been expanded and established long-term telehealth policies for many providers. This means telehealth is going to stay as a permanent billing category.
3. Mental Health Parity Enforcement Gets Real
The MHPAEA final rule took full effect in 2025 and is being enforced strictly in 2026. This means commercial insurers cannot apply tighter prior authorization or coverage criteria for mental health than for physical health and that includes telehealth services. Practices that were getting denials on telehealth claims can now challenge them under parity law. But all this only works if you bill with the correct code modifiers and Place of Service code.
Key ForwardHealth Telehealth Billing Considerations
Mental health practices in Wisconsin billing for Medicaid (ForwardHealth) telehealth services must comply with specific technical, clinical and billing requirements established by the Wisconsin Department of Health Services and ForwardHealth. Here are the critical considerations based on official Wisconsin state sources:
Covered Services and Modalities
In Wisconsin, services like mental health, substance abuse and behavioral treatments are covered under telehealth services. ForwardHealth reimburses telehealth services delivered using communication technology that allows two-way, real-time interaction, including both "audio-visual" and "audio-only" communication. This means providers can deliver individual psychotherapy, psychiatric evaluation, medication management and group therapy via video or phone and receive Medicaid reimbursement for both modalities.
ForwardHealth has expanded the definition of telehealth in its permanent policy to mean the use of telecommunications technology by a Medicaid-enrolled provider to deliver functionally equivalent health care services including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data and may include real-time interactive audio-only communication.
Billing Requirements: Procedure Codes and Modifiers
Telehealth mental health claim is also submitted using the same CPT procedure codes as you would for in-person service. Only that you will be indicating the service modality through the modifier and Place of Service code, not with a different CPT code.
Claims for services provided via telehealth by distant site providers must be billed with the same procedure code as would be used for a face-to-face encounter along with HCPCS modifier GT (via interactive audio and video telecommunication systems). Modifier GT signals to ForwardHealth that the service was delivered via real-time interactive audio and video.
For audio-only services, different modifier rules may apply depending on whether you are billing as an individual provider or as a clinic (FQHC/RHC). Behavioral health services should be indicated with valid modifiers.
Place of Service Code Requirements
This is where most Wisconsin practices make their first mistake. You must use the correct POS code, or your claim will be denied or rejected.
POS Code 02: Telehealth (Not in Patient's Home)
Use this when the patient is receiving telehealth from any location other than their home like office, a clinic, a therapist's virtual office in another building, etc.
POS Code 10: Telehealth (Patient's Home)>
Use this when the patient is receiving telehealth while physically in their own home.
Always confirm the patient's location before your session starts. If they're at home, use POS 10. If they're elsewhere, use POS 02. Also verify the specific POS code and modifier requirements with ForwardHealth for your provider type and billing entity (individual provider vs. clinic). Requirements may vary based on whether you bill professional claims or institutional claims.
Not sure your telehealth claims are coded correctly?
Wrong POS code, missing modifier, or mismatched documentation can mean silent underpayment for months before anyone notices. Get a free telehealth billing audit from Shoreline, we’ll review a sample of your recent claims and flag exactly where you're leaving revenue on the table.
Reimbursement Rate Parity
ForwardHealth reimburses the service rendered by distant site providers at the same rate as when the service is provided face-to-face. This means a 45-minute psychotherapy session delivered via telehealth (CPT 90834-GT) receives the same reimbursement as an in-person session, there is no rate reduction for telehealth delivery.
Service Quality and Technical Requirements
Services provided via telehealth must be functionally equivalent to an in-person visit, meaning that the transmission of information must be of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable. Any technical failures that significantly interrupt the session may affect your ability to bill for the full-time claim. Always use HIPAA-compliant video platforms.
Originating Site Restrictions and Coverage
ForwardHealth allows coverage of telehealth for any originating site meaning patients can receive services from home, their workplace, a clinic, or other locations. However, the originating site is defined as where the patient or member is located, including a home, pharmacy, homeless shelter, assisted living provider etc.
Provider Eligibility
Ph.D. psychologists and other qualified mental health providers may be reimbursed for providing telehealth services at a distant site. However, providers must be enrolled as Medicaid providers with ForwardHealth. If your license type or credentials are not verified with ForwardHealth as eligible for telehealth, your claims will deny regardless of the coding accuracy.
All Psychotherapy services shall be covered services when provided by a provider certified under state rules, and via telehealth when the provider is in a location that ensures privacy and confidentiality of recipient information and communications.
Verify Your Provider Type and Eligibility
Before submitting telehealth mental health claims to ForwardHealth, confirm:
- ✔ Your license type and credentials are enrolled with ForwardHealth as an approved distant site provider.
- ✔ Your specific provider type modifier requirements (which may differ if you bill as an individual psychologist vs. a clinic mental health provider).
- ✔ Whether your claims should use POS 02, and which modifier(s) apply to your specific service delivery (GT vs. other modifiers).
- ✔ Your eligibility for originating site facility fees if applicable.
Informed Consent
Providers must obtain member consent for telehealth services, including informing the member of any applicable copay or cost sharing that may apply.
- ✔ Get written consent from patients before their first telehealth session
- ✔ Discuss privacy, confidentiality, and technical limitations
- ✔ Document consent in the medical record
Wisconsin License Portability (PSYPACT)
Wisconsin is a member of the Psychology Interjurisdictional Compact (PSYPACT), therefore licensed psychologists from other compact states can provide temporary telepsychology services to Wisconsin patients. This requires registration and compliance with Wisconsin's rules. So, if you're a psychologist licensed in another state and offering telehealth to Wisconsin patients it expands your market reach.
Best Practices for Mental Health Telehealth Billing
1. Use Real-Time Eligibility Verification
Don't assume coverage. Confirm network status, parity terms and any telehealth riders before scheduling virtual visits. ForwardHealth members can be verified through the ForwardHealth Portal in real-time by integrating the real-time verification tools in your practice management software.
2. Document the 5/6 Rule Compliance
Every session note should show:
- ✔ Start time, end time, total direct contact time
- ✔ Any time spent on administrative tasks (separate from the therapy time you bill)
- ✔ Proof that at least 5/6 of the claimed time was direct patient contact
3. Build Telehealth Preferences into Your Workflow
- ✔ Ask patients at intake: "Do you prefer video or phone for your sessions?"
- ✔ Document their preference in the patient profile
- ✔ Confirm the modality at check-in for each session
- ✔ Use the modifier that matches the actual modality
4. Create a Pre-Telehealth Checklist
Before every telehealth session physician should
- ✔ Confirm internet connection stability
- ✔ Check audio/video in your telehealth platform
- ✔ Ensure privacy
- ✔ Have the patient chart open and ready
- ✔ Confirm patient location (home vs. elsewhere)
- ✔ Have emergency protocols in place
- ✔ Confirm patient identity (security/safety)
5. Monitor Payer-Specific Rules
Not all payers follow the same telehealth rules:
- ✔ ForwardHealth: Covers and pays parity for telehealth mental health
- ✔ Anthem Wisconsin: Generally, covers telehealth at parity
- ✔ UnitedHealth: Check each specific plan for telehealth riders
Subscribe to payer updates to stay current.
How Shoreline Approaches Mental Health Telehealth Billing
Here's what we've learned from working with Wisconsin mental health practices for years:
Pre-Visit Preparation is Everything
So, before the clinician ever logs in, we confirm eligibility, prior authorization status, and patient location. This catches 80% of billing problems before they happen.
Clinical Documentation Templates Matter
We build behavioral health specific EHR documentation templates that automatically capture start time, end time, specific therapeutic interventions and modality (video vs. phone). When templates guide the chart, denials drop significantly.
Claim Submission Protocol
We don't just submit claims; our predictive analysis tool verifies the:
- ✔ Correct POS code based on patient location
- ✔ Correct modifiers (GT, 93) based on the modality
- ✔ Checks whether documentation supports the CPT code selected
- ✔ Diagnosis codes are specific and medically necessary
- ✔ It also predicts the probability of the claims being passed on first pass so that we can recheck the claims and submit them before they enter the payers adjudication.
Denial Root-Cause Analysis
Our denial intelligence tool analyze denials by payer, code and provider type that helps practices to adjust it before becoming a pattern.
Payer Appeal Strategy
For claims that were denied on the parity grounds, we appeal with regulatory references and documentation of medical necessity. We have built customized real-time dashboards for mental health practices to track the KPIs in real time and generate reports on monthly basis, so that we can catch the billing problems early and increase your cash flow.
We understand Wisconsin's ForwardHealth rules, commercial payer quirks, and the compliance nuances that trip up solo practices and larger clinics alike. We help providers in Wisconsin to identify exactly where their revenue is leaking, help them fix their documentation templates and establish a clean claim protocol that works. We at Shoreline Medical Billing combines AI-driven automation with deep clinical knowledge to solve the exact billing problems that mental health practices face.
FAQs
Q1.What’s the difference between synchronous and asynchronous telehealth?
+Synchronous telehealth is using real-time video for therapy sessions that can be billed. Asynchronous telehealth is where the patient records video and sends it to the provider for review to be watched later. This is rarely covered for behavioral health therapy. So always stick with the synchronous method.
Q2.Can the providers record telehealth sessions?
+Yes. But only with the written patient consent. And document consent along with the clinical chart. Also keep the recording in secure location (HIPAA compliant storage).
Q3.Does provider need to get prior authorization for all telehealth sessions?
+No. For most covered mental health services, no prior authorization is required. It is usually needed for the initial telehealth therapy or increased frequency. Always check the insurance plan and guidelines before rendering the services.
Q4: Does Wisconsin mandate telehealth parity? Do I get paid the same for telehealth as in-person?
+The state law of Wisconsin generally requires health insurance policies to cover telehealth services at the same rate as in-person services. ForwardHealth and most commercial payers in Wisconsin reimburse telehealth mental health at parity (same rate). But always check your specific contracts because some older plans may have carve-outs.
Sharanya Rajmohan
Content Writer
Sharanya brings clarity to the complexities of medical billing and healthcare regulations. With a knack for turning industry shifts into straightforward, actionable insights, her blogs help readers stay informed without the jargon.
Ready to stop losing revenue to telehealth billing mistakes? Contact Shoreline Medical Billing Company Today for a FREE revenue audit.