Behavioral Health Telemedicine and Virtual Visits

Mental Well-Being powered by Spring Health offers an expanded network of behavioral health providers in addition to a digital experience. Highmark’s partnership with Spring Health expands timely access to mental and behavioral health care for Highmark members. Mental Well-Being features personalized care throughout the continuum (low to high acuity needs) from self-guided tools and wellness coaching to virtual care with a therapist or psychiatrist and 24/7 crisis support. Click the link below to refer a patient to Mental Well-Being and Spring Health will reach out to the patient.

Spring Provider Referral Program

(Referrals Accepted Starting January 1, 2024)

For additional information about Mental Well-Being and Reference Guide, click the links below:

• Additional Information About Mental Well-Being

• Reference Guide of Highmark Member Programs.

Note: Mental Well-Being is available to Commercial, Medicare Advantage, and ACA members in Delaware, New York, Pennsylvania, and West Virginia (age 6 or older).

Well360 Virtual Behavioral Health provides virtual psychiatry and therapy services for members seeking care for conditions like depression, anxiety, stress management, relationship challenges, and child behavior difficulties. Services also include talk therapy, counseling, medication management, and more.

For comprehensive information about Well360 Virtual Behavioral Health and Reference Guide, click the links below:

• Well360 Virtual Behavioral Health

• Reference Guide of Highmark Member Programs.
  

Note: Well360 Virtual Behavioral Health is available to Commercial, Medicare Advantage, and ACA members in Delaware, Pennsylvania, and West Virginia. Therapy services are provided to children (ages 10-17) and adults. Medication management is provided to adults (age 18 or older).

Highmark reimburses mental health providers for outpatient care delivery. Please see Highmark's Provider Manual Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.

Provider Manual Chapter 2, Unit 5

Yes, in an effort to increase access to behavioral health treatment, Highmark has contracted with providers that offer comprehensive virtual treatment for specific behavioral health conditions. 

Listed below are the available support programs. For insights into each program and referral procedures, click the ‘Reference Guide of Highmark Member Programs’.

Reference Guide of Highmark Member Programs.

*Note: In-network providers do not need to utilize these vendor services to provide telehealth services to Highmark members. These vendors are a separate option and benefit to certain members.

Please see Highmark’s Provider Manual Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.

Provider Manual Chapter 2, Unit 5

*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow The Centers for Medicare and Medicaid Services (CMS) guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.

CMS Guidelines

Highmark will continue to reimburse providers for virtual visits at parity with face-to-face services if the services:

1. Are eligible for separate reimbursement
2. Are part of the member's benefit
3. Fully meet the definition of the code and can be safely and effectively delivered through a virtual option
4. Are not specifically disallowed by a Highmark medical or reimbursement policy

The use of place of service 02 (Telehealth Provided Other Than in Patient's Home) or 10 (Telehealth Provided in Patient's Home) for 1500 claims when billing for virtual health services is still required along with the appropriate use of modifier 95 on the applicable claim lines.

*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow The Centers for Medicare and Medicaid Services (CMS) guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.

CMS Guidelines

For more information on billing and reimbursement for commercial and Medicare Advantage products, please see Highmark Reimbursement Policy RP-046: Telemedicine and Telehealth Services.

Reimbursement Policy RP-046