Are there specific telehealth platforms required for parity coverage?

Most parity laws don't mandate specific platforms, but they do require HIPAA-compliant technology such as ICANotes. Some insurers may have preferred vendor lists or technical requirements. Audio-only sessions are covered under many parity laws, especially for behavioral health services, but video capability may be required for certain types of visits.

Can I bill the same CPT codes for telehealth as I do for in-person visits?

Yes, most telehealth visits use the same CPT codes as in-person visits, but you must add specific modifiers or place-of-service codes depending on your state and payer requirements. Some insurers require modifier 95 for telehealth services, while others use place-of-service code 02. Always verify specific billing requirements with each payer before submitting claims.

Do telehealth parity laws apply to out-of-state patients?

Telehealth parity laws typically apply based on where the provider is licensed and where the patient is located during the session. If you're treating a patient in a different state, that state's telehealth laws may govern coverage and reimbursement. You must also hold valid licensure in the state where the patient is receiving services.

Do parity laws cover group therapy sessions conducted via telehealth?

Coverage for telehealth group therapy varies by state and insurer. While many parity laws include group behavioral health services, some require special authorization or limit the number of participants. Check with individual payers about their specific policies for group telehealth sessions and any required pre-authorization processes.

What documentation do I need to prove telehealth services meet parity standards?

Document the same clinical information required for in-person visits, plus telehealth-specific details like technology used, patient consent for telehealth, and location of both provider and patient. Maintain records showing the service provided the same therapeutic value as an in-person visit. Some states require specific telehealth consent forms.

How do I appeal a denied telehealth claim when parity laws should apply?

Start by reviewing your state's specific parity requirements and gather documentation showing your service qualifies for equal reimbursement. Submit a formal appeal with your insurer, citing the relevant parity law and including supporting documentation. If the appeal is denied, contact your state insurance commissioner's office for assistance with parity law enforcement.

Can insurers require prior authorization for telehealth services under parity laws?

Insurers can require prior authorization for telehealth services, but under parity laws, the authorization requirements must be the same as for equivalent in-person services. They cannot impose additional authorization burdens solely because the service is delivered via telehealth. If prior authorization is required for in-person visits, it can also be required for telehealth.

Is a separate "Informed Consent" required for EMDR?

While not always legally mandated beyond standard consent, it is clinical best practice. Document that the client was informed about the risk of "high emotional arousal" and "post-session processing." Note their agreement to use the Safe/Calm Place and their understanding that they can stop bilateral stimulation at any time.

What should the therapist say when checking the VOC during the installation phase?

During the Installation phase, the therapist asks the client to hold the target image and positive cognition together in mind, then rate how true the positive belief feels on a scale of 1 (completely false) to 7 (completely true). A typical prompt might be: "When you think of the original experience, how true do the words [positive cognition] feel to you now, on a scale of 1 to 7?" The therapist repeats this check after each set of bilateral stimulation until the client reaches a VOC of 7.

How do you explain EMDR to clients?

When preparing clients for EMDR, explain that it's a structured therapy designed to help the brain process distressing memories so they no longer trigger strong emotional or physical reactions. You might say something like: "During EMDR, I'll ask you to briefly focus on a difficult memory while following my finger with your eyes. This bilateral stimulation helps your brain reprocess the memory so it becomes less distressing over time." Emphasize that they won't need to describe the event in detail, which often puts anxious clients at ease.

What is assessed during EMDR Phase 1 history taking?

During Phase 1, the clinician gathers the client's history across three time frames: past disturbing memories, present-day triggers and symptoms, and future goals. The therapist identifies target memories, maps them on a timeline, explores the client's negative and positive self-beliefs related to those experiences, and determines which target to address first in treatment. This phase typically takes one to two sessions.

What three things should the clinician ask the client to notice when beginning desensitization?

When starting the desensitization phase, the clinician asks the client to hold three things in mind simultaneously: the target image associated with the disturbing memory, the negative cognition (their negative self-belief about the experience), and any body sensations they notice while focusing on the image and belief. The client maintains awareness of all three while performing bilateral stimulation.

How long does EMDR therapy take?

EMDR is a short-term therapy. Sessions typically occur once or twice a week and run about 90 minutes each — longer than the standard 45-minute therapy session. Most clients complete treatment in six to 12 sessions, though some may benefit from fewer. The total length depends on the complexity of the client's history and the number of target memories identified during Phase 1.

What's the difference between SUD and VOC in EMDR?

SUD (Subjective Units of Disturbance) measures how distressing a target memory feels to the client on a scale of 0 to 10, where 0 is no disturbance and 10 is the worst imaginable. VOC (Validity of Cognition) measures how true the client's positive self-belief feels on a scale of 1 to 7, where 1 is completely false and 7 is completely true. During treatment, the goal is to bring SUD down to 0 and VOC up to 7. Clinicians track both ratings across sessions to measure processing progress.

What does a completed EMDR session look like?

A fully completed EMDR processing session ends with the client achieving a SUD of 0, a VOC of 7, and a clean body scan — meaning they can hold the target memory and positive cognition in mind without noticing any residual distress or tension in their body. The therapist then conducts a debriefing, letting the client know they may continue processing after the session and encouraging them to note any thoughts, feelings, or dreams that arise. See the EMDR progress note examples above for detailed documentation of both in-progress and completed sessions.

How do I document "Looping" or "Processing Blocks" in Phase 4?

When a client stays stuck at a high SUD, document the specific "interweave" used (e.g., cognitive, imaginative). Note the shift from "processing" to "active intervention." This demonstrates medical necessity by showing the clinician’s active role in moving the client past a neurological stalemate rather than just passive observation.

How should I document "Atypical" Bilateral Stimulation (BLS)?

If using tactile buzzers, tapping, or audio tones instead of eye movements, document the specific modality and the clinical reason for the choice (e.g., "visual fatigue" or "client preference"). Consistently recording the type of BLS used ensures continuity of care if the client transitions to another provider.

October Boyles, DNP, MSN, BSN, RN, Author at ICANotes

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