Access & Insurance

How Online Psychiatry Works with Insurance in North Carolina

Q: Does insurance cover telehealth psychiatry in North Carolina?

Yes. North Carolina law (G.S. 58-3-295) requires that commercial insurance plans cover telehealth services at the same rate as in-person services (telehealth parity). NC Medicaid also covers telehealth psychiatric services. This means your copay, coinsurance, and deductible apply the same way they would for an in-person psychiatric appointment.

Q: Is telehealth psychiatry billed differently than in-person?

Telehealth psychiatric appointments use the same CPT billing codes as in-person visits, with a telehealth modifier (95 or GT) added to indicate the service was delivered remotely. Thanks to NC's telehealth parity law, insurers must reimburse these at the same rate. Your cost-sharing (copay or coinsurance) is identical to an in-person visit.

Q: What do I need for a telehealth psychiatry appointment?

You need: a device with a camera and microphone (smartphone, tablet, or computer), a stable internet or data connection, a private space where you can speak freely, and your insurance card and photo ID. Most telehealth platforms work through a web browser — no app download required.

June 1, 20259 min readNorth Carolina

One of the most common questions before booking a telehealth appointment is: "Will my insurance cover this?" The answer is almost always yes — and North Carolina law backs it up. Here's exactly how it works.

Written by

Afi Kpakossou, PMHNP-BC

Psychiatric Mental Health Nurse Practitioner

Medically reviewed by

Afi Kpakossou, PMHNP-BC

Psychiatric Mental Health Nurse Practitioner

Published

June 1, 2025

Read time

9 min read

Content is written and reviewed by licensed psychiatric providers at Pinnacle BHW following clinical guidance and peer-reviewed literature. Learn about our editorial standards →

Quick Facts: How Online Psychiatry Works with Insurance in NC

✓ NC Medicaid, BCBS, Aetna, Cigna & most major insurance accepted
✓ No referral required for telehealth psychiatric appointments
✓ Same-day appointments available for new and existing patients
✓ Serving all of North Carolina via secure HIPAA-compliant telehealth
✓ ADHD, anxiety, depression, PTSD & insomnia all covered by most plans
✓ Self-pay options also available — ask about sliding scale fees

North Carolina Telehealth Parity Law (G.S. 58-3-295)

NC law requires commercial insurers to cover telehealth services at parity with in-person services — meaning the same reimbursement rates and the same cost-sharing apply. You pay the same copay or coinsurance for a telehealth psychiatric visit as you would for an in-person one.

How Telehealth Psychiatry Is Billed

Telehealth psychiatric appointments are billed to insurance using the same Current Procedural Terminology (CPT) codes as in-person visits.

The key CPT codes used in psychiatric medication management are 99205 or 99213–99215 (evaluation and management visits) and 90792 (psychiatric diagnostic evaluation).

A telehealth modifier — typically modifier 95 (synchronous telemedicine) or GT — is appended to indicate the service was delivered via video.

Under NC's telehealth parity law, insurers cannot reimburse telehealth services at a lower rate than in-person equivalents simply because they were delivered remotely.

This means Pinnacle BHW bills your insurance the same way a traditional psychiatry office does, and your cost-sharing (copay, coinsurance, deductible) is applied identically.

After your appointment, Pinnacle BHW submits the claim to your insurance electronically. Your insurer processes the claim and applies your benefits — deductible if not yet met, then your copay or coinsurance percentage.

You'll receive an Explanation of Benefits (EOB) from your insurer showing what was billed, what they paid, and what you owe. The patient portion is typically collected at or near the time of service.

Coverage by Insurance Type

NC Medicaid (Managed Care)

Full coverage — $0 copay for most services

→NC Medicaid covers live video telehealth (synchronous) for psychiatric evaluation and medication management
→Covered services include initial psychiatric evaluation (90792), E&M follow-up visits (99213–99215), and medication management
→Most Medicaid enrollees have $0 or very low copays for mental health services
→Provider must be enrolled as a Medicaid provider and your plan's network
→Audio-only telehealth may have limited coverage — video is the standard

Commercial PPO Insurance

Covered — copay or coinsurance applies

→Telehealth psychiatric visits are covered at parity with in-person under NC law
→You pay your standard mental health specialist copay (commonly $20–$60) or coinsurance (typically 20–40% after deductible)
→Deductible applies if not yet met for the year
→In-network vs out-of-network rates differ significantly — always verify in-network status before booking
→Check your Summary of Benefits for "outpatient mental health specialist" cost-sharing

Commercial HMO Insurance

Covered — may need PCP referral first

→Telehealth psychiatric services are covered if provider is in-network
→HMO plans may require a referral from your PCP before the visit is covered
→Many HMO plans have behavioral health carve-outs allowing direct access — call to confirm
→Out-of-network telehealth typically not covered under HMO plans
→Cost-sharing is typically a specialist copay similar to PPO plans

Medicare

Covered under Medicare Part B

→Medicare Part B covers telehealth psychiatric services at 80% of approved amount after Part B deductible
→You pay 20% coinsurance (Medigap/supplemental insurance may cover this)
→Medicare Advantage plans have varying telehealth coverage — check your plan
→Effective since COVID-19 telehealth expansion, coverage has been broadly maintained

What You Need for a Telehealth Psychiatric Appointment

A device with camera & mic

Smartphone, tablet, or computer — any device that can support a video call works. Most platforms run directly in a web browser.

Stable internet connection

A WiFi or cellular data connection capable of supporting video. Most home internet and 4G/5G mobile connections are sufficient.

A private space

You'll discuss sensitive health information. Find a space where you can speak freely without being overheard — a bedroom, parked car, or private office works.

Insurance card & photo ID

Your Medicaid card or commercial insurance card, plus a government-issued photo ID. These are verified before your first appointment.

How to Verify Your Telehealth Coverage Before Booking

While telehealth parity laws and Medicaid coverage make it very likely your appointment is covered, verifying your specific benefits before your first appointment avoids surprises. Here's what to check:

Call your insurance member services

The number is on the back of your insurance card. Ask: "Do I have outpatient mental health coverage? Is telehealth covered at parity? What is my copay or coinsurance for a mental health specialist visit? Do I have a deductible, and has it been met?"

Verify Pinnacle BHW is in-network

Ask specifically: "Is Pinnacle Behavioral Health & Wellness in Charlotte, NC, in-network for my plan?" Or provide the NPI number. This ensures you receive in-network cost-sharing rates.

Understand your deductible situation

If your deductible has not been met for the year, the full cost of the visit (minus any negotiated rate) applies toward your deductible before your copay or coinsurance kicks in. This is true for both telehealth and in-person visits.

Confirm prior authorization (if any)

Some plans require prior authorization for psychiatric evaluation visits. This is uncommon for initial outpatient visits but worth confirming. Pinnacle BHW can assist with prior authorization if needed.

What You'll Typically Pay

Insurance Type	Initial Evaluation	Follow-Up Visits
NC Medicaid	$0–$3	$0–$3
Commercial PPO (deductible met)	$20–$60 copay	$20–$50 copay
Commercial PPO (deductible not met)	Negotiated rate toward deductible	Negotiated rate toward deductible
Medicare Part B	20% of approved amount	20% of approved amount
Self-Pay	Contact office for rates	Contact office for rates

Estimates only. Your actual costs depend on your specific plan benefits. Verify with your insurer.

Ready to Book Your Telehealth Appointment?

Pinnacle BHW accepts NC Medicaid and most commercial insurance plans. Telehealth psychiatric evaluation and medication management — from anywhere in North Carolina.

Check Availability & Book

Frequently Asked Questions

Does insurance cover telehealth psychiatry in North Carolina?

Yes. NC law (G.S. 58-3-295) requires commercial insurance plans to cover telehealth services at parity with in-person services. NC Medicaid also covers telehealth psychiatric services. Your copay, coinsurance, and deductible apply the same way they would for an in-person appointment.

Is telehealth psychiatry billed differently than in-person?

Telehealth visits use the same CPT billing codes as in-person visits, with a telehealth modifier added. Thanks to NC's parity law, insurers reimburse at the same rate. Your cost-sharing is identical to an in-person visit.

Does NC Medicaid cover telehealth psychiatric appointments?

Yes. NC Medicaid covers telehealth psychiatric evaluation and medication management delivered via live video. This includes initial evaluations and follow-up medication management.

What do I need for a telehealth psychiatry appointment?

You need: a device with a camera and microphone, stable internet or data connection, a private space to speak freely, and your insurance card and photo ID.