"May deliver" does not automatically mean "may bill independently."
The claim must satisfy the service-code table, practitioner taxonomy, scope of practice, enrollment, supervision, consent, documentation, modifier, and place-of-service requirements.
Telehealth is a delivery method—not a separate behavioral-health benefit. DHCS states that an equivalent medically appropriate service should be reimbursed at the same rate whether delivered in person, by video, or by telephone (BHIN 23-018).
Source: DHCS BHIN 23-018 • Verify current county & MCP billing manuals prior to submission.
Request A ConsultationBehavioral Health Telehealth in Action
Discover how our virtual care model connects Medi-Cal members with specialized licensed therapists, reducing wait times and expanding access across care networks.
Duration
:31 mins
Compliance
CalAIM & HIPAA Ready
Topic
Telehealth Operations
Modality summary
These delivery rules apply to Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and DMC-ODS under DHCS BHIN 23-018 guidance.
Telehealth is a delivery method, not a separate benefit. Services are reimbursed at the same rate whether delivered in person, by video, or by telephone.
Generally reimbursable for covered services when clinically appropriate, consented to, documented, and provided by an eligible enrolled provider.
- BHIN 23-018 identifies GT modifier
- Requires beneficiary consent and documentation
- Applies across eligible SMHS, DMC, and DMC-ODS services
Generally reimbursable when clinically appropriate and allowed by service rules. New-patient establishment is restricted unless specific exceptions apply.
- BHIN 23-018 identifies SC modifier
- Exception 1: Service is sensitive in nature
- Exception 2: Beneficiary requests audio-only or lacks video access
Excluded from BHIN 23-018's general behavioral-health telehealth definition. An authorized DMC-ODS e-consult may utilize GQ.
- Not covered under general BHIN 23-018 telehealth scope
- Authorized DMC-ODS e-consults use GQ modifier
- Subject to strict plan and county billing manuals
Residential, crisis stabilization, day treatment/rehabilitation, psychiatric-facility, and inpatient services require an established site and some in-person contact.
- Telehealth allowed for eligible components only
- Does not eliminate mandatory facility site requirements
- Requires documented in-person clinical touchpoints
Sources & verification
StratiHealth™ aligns implementation directly to current Department of Health Care Services (DHCS) guidance, ensuring full regulatory compliance for CalAIM behavioral health telehealth operations and claiming workflows.
Telehealth is a delivery method—not a separate behavioral-health benefit. DHCS states that an equivalent medically appropriate service should be reimbursed at the same rate whether delivered in person, by video, or by telephone.
Verify the current county, MCP, DMC, or DMC-ODS billing manual before submitting claims.
CalAIM Behavioral Health Telehealth
Telehealth serves as an essential delivery method within California's Medi-Cal transformation. StratiHealth™ partners with MHPs, MCPs, DMC/DMC-ODS providers, and county organizations to deliver services and maintain compliant billing practices.
4 service lanes
OverviewIntegrated Medi-Cal delivery framework
GT · video
Mod GTSynchronous audio-visual telehealth
SC · audio-only
Mod SCSynchronous audio-only phone encounters
GQ · DMC-ODS e-consult
Mod GQAsynchronous store and forward transmission
Implement CalAIM telehealth with confidence.
Tailored clinical care models and operational consulting for Mental Health Plans (MHP), Managed Care Plans (MCP), and DMC-ODS providers.
Full provider × service matrix
CalAIM Behavioral Health Telehealth guidance cross-referencing covered service lanes, practitioner eligibility, billing rules, and modifier requirements.
| CalAIM service lane | Covered services (Telehealth) | Who may deliver | Who may bill/render | Modalities and key limits |
|---|---|---|---|---|
Specialty Mental Health Services — SMHS/MHPSMHS / MHP | Mental-health assessment, individual/group/ family therapy, rehabilitation, medication support, crisis intervention components, targeted case management, and peer-support services when the specific code permits telehealth. | Physicians, psychologists, LCSWs, MFTs, LPCCs/PCCs, nurse practitioners, clinical nurse specialists, RNs, LVNs, licensed psychiatric technicians, physician assistants, pharmacists, occupational therapists, medical assistants, clinical trainees, medical students in clerkship, Community Health Workers, Mental Health Rehabilitation Specialists, Peer Specialists, AOD Counselors, and Other Qualified Providers—only for services allowed by the applicable service table. | A Medi-Cal-enrolled MHP/provider entity with an eligible rendering practitioner, matching taxonomy, and an allowable procedure code. Clinical trainees and CHWs require supervisor information; the supervisor co-signs the note and assumes responsibility. | Synchronous video and audio-only are generally reimbursable. Under BHIN 23-018, use GT for video and SC for audio-only. Residential, crisis stabilization, day treatment/rehabilitation, psychiatric-facility, and inpatient services require an established site and some in-person contact. SMHS Billing Manual SFY 2025–26BHIN 23-018 |
Drug Medi-Cal / DMC-ODS — SUD servicesDMC-ODS / SUD | SUD assessment and counseling, individual/group/ family therapy, medication services, patient education, crisis-intervention services, residential-treatment components, and other covered DMC/DMC-ODS services. | LPHAs: physicians, NPs, PAs, RNs, registered pharmacists, licensed clinical psychologists, LCSWs, registered CSWs, LPCCs, registered PCCs, LMFTs, registered MFTs, LVNs, licensed occupational therapists, and licensed psychiatric technicians. Also AOD Counselors, qualifying clinical trainees, qualifying CSW/MFT/PCC candidates, certified Peer Support Specialists, and Other Qualified Providers where permitted by the service table. | An enrolled DMC/DMC-ODS provider with an eligible rendering practitioner and matching taxonomy/procedure code. Only the provider directly rendering care may bill a Clinician Consultation service; the clinician merely giving advice may not bill that service. Peer Specialists may bill designated peer-support services only when certified and when the code permits. | Synchronous video and audio-only are generally reimbursable. Under BHIN 23-018, use GT for video and SC for audio-only. GQ may apply to an authorized DMC-ODS e-consult. New-patient audio-only establishment is restricted; residential and facility-based services require an established site and some in-person contact. DMC-ODS CalAIM FAQBHIN 23-018 |
Non-Specialty Mental Health Services — NSMHS/MCPNSMHS / MCP | Mental-health evaluation and treatment, individual/group/family psychotherapy, clinically indicated psychological and neuropsychological testing, outpatient drug-therapy monitoring, psychiatric consultation, and related outpatient laboratory, drug, supply, and supplement services. | Not fully specified in APL 22-006. The APL directs plans and providers to the Medi-Cal Non-Specialty Mental Health Services: Psychiatric and Psychological Services Provider Manual for the eligible practitioner list and CPT-specific rules. | An MCP-contracted or otherwise eligible Medi-Cal provider rendering a covered CPT service under the applicable manual, scope-of-practice, enrollment, and plan-contract requirements. | Telehealth availability, modifiers, and practitioner eligibility are manual- and CPT-specific. APL 22-006 does not itself enumerate the complete provider list. APL 22-006NSMHS Provider Manual |
ECM / Community SupportsECM / Managed Care | These are Medi-Cal managed-care benefits and cost-effective alternatives administered through MCP networks; they are not identified in the cited BHIN 23-018 guidance as a separate behavioral-health telehealth service lane. | Not specified in the cited behavioral-health telehealth guidance. Provider eligibility depends on the applicable ECM/Community Supports policy, MCP contract, service definition, and provider terms. | Not specified in the cited behavioral-health telehealth guidance. Billing is generally through the applicable MCP/ECM/Community Supports arrangement rather than SMHS or DMC/DMC-ODS county claiming. | Do not infer SMHS or DMC/DMC-ODS telehealth modifiers or provider lists for ECM/Community Supports. DHCS ECM and Community Supports |
Modality Summary
BHIN 23-018 RulesSynchronous video
Generally reimbursable for covered services when clinically appropriate, consented to, documented, and provided by an eligible enrolled provider. BHIN 23-018 identifies GT.
Synchronous audio-only
Generally reimbursable when clinically appropriate and allowed by the service rules. New-patient establishment is restricted unless sensitive service, beneficiary requests, or lacks video access. BHIN 23-018 identifies SC.
Asynchronous store-and-forward
Excluded from BHIN 23-018’s general behavioral-health telehealth definition. An authorized DMC-ODS e-consult may use GQ.
Residential & Facility Services
Require an established service site and some in-person contact. Telehealth may be used for eligible components, but does not eliminate facility or in-person requirements.
Claiming Caution
Important Notice“May deliver” does not automatically mean “may bill independently.” The claim must satisfy the service-code table, practitioner taxonomy, scope of practice, enrollment, supervision, consent, documentation, modifier, and place-of-service requirements. Telehealth is a delivery method—not a separate behavioral-health benefit. DHCS states that an equivalent medically appropriate service should be reimbursed at the same rate whether delivered in person, by video, or by telephone.
Sources: DHCS BHIN 23-018; APL 22-006; DMC-ODS CalAIM FAQ; DHCS Telehealth FAQ; SMHS Billing Manual SFY 2025–26. Always verify current county, MCP, DMC, or DMC-ODS billing manuals before submitting claims.