How You Can Conduct Sessions Outdoors and Bill for Your Services


One therapist we talked to recently put it this way: “I spend every day trying to figure out how to bring people together without being together.  It’s maddening!”

In this blog post, we explore three options therapists can consider that would allow them to provide face-to-face individual, couples and family counseling outdoors where it is easier to practice social distancing.  First we’ll discuss three scenarios where you can conduct a session outdoors and how to bill insurance for those sessions.  Then we’ll make some general billing suggestions.  And, finally, we’ll briefly discuss some things to consider before you commit to providing services outdoors.



The first scenario we found to consider is providing services on the property of your office building.  Many commercial office buildings have well-landscaped property with dedicated break areas.  Look for seating areas or walkways where you could comfortably and safely meet with a client while remaining within the surveyed boundaries of the property.

“As long as you conduct the session within the site premises, you can use the place of service code you normally use for in-person sessions at your office,” explained Amin Franklin, Certified Professional Coder at Substance Solutions.

But it may not be that simple for everyone, Franklin warned.

“This only works if the address associated with your NPI number covers the entire building and property,” he explained.  “If you have a suite number as part of your address, you cannot provide services outside of the suite.”

That last rule may eliminate many providers from using this option, but we still have two more scenarios to consider for the rest of you.



providing in home counselingThe Center for Medicare & Medicaid Services lists approved place of service codes, including Home, which is defined as a “location, other than a hospital or other facility, where the patient receives care in a private residence.”

Obviously providing care inside someone’s home during a pandemic is not appropriate.  For those patients who have a deck, back yard seating or a pavilion where you can comfortably, safely and privately meet, this could be a great option.  Many apartment complexes, for example, have such areas.

“In this scenario, you’re free to meet the client anywhere on their property even if it’s an apartment complex,” Franklin said.  “But you cannot go across the street to the city-owned park and still bill under this place of service code.”



place of service code 18For those individuals who work on corporate campuses where there are well-landscaped break areas, walking paths on the property and covered pavilions, using Place of Service Code 18 may be a good option for you.

POS Code 18 can be used to bill for sessions conducted at “a location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic, or rehabilitative services to the individual.” (Medicare Learning Network Matters CR8125)

For those individuals who work on corporate campuses where there are well-landscaped break areas, walking paths on the property and covered pavilions, using Place of Service Code 18 may be a good option for you.

“Medicare and Medicaid do not allow you to bill this place of service code,” Franklin warned.  “And every insurance plan may have different codes it will allow.”

This leads us to the next section.



Policies and procedures change rapidly in this pandemic environment, so we have a few recommendations for those who may want to try any of these three practice scenarios out.

  • When verifying a client’s benefits, ask which place of service codes are allowed.
  • Choose one patient to try this service delivery model on first. Once you have confirmed the billing process works with one insurance company, try it with another insurance company until you develop confidence.
  • Documentation will be important in an insurance audit. When providing services outdoors be specific about where the services were provided. For example, “Session conducted at 555 Location Ave. beneath the client’s carport due to COVID-19 social distancing concerns” would be much better than “Session conducted outside of client’s home.”



Working outdoors has some unique challenges to consider.  Here are some things to consider before conducting therapy sessions outdoors:

  • Reconnoiter the possible meeting places in advance, so you can identify multiple plans of action in case of bad weather, other people occupying the spot you had planned to meet at or noise concerns.
  • Develop several strategies you can use to ensure patient confidentiality during the session.
  • Have a plan for what happens when you encounter someone you know during walk-and-talk therapy.
  • Consider what kind of therapy work you’re doing with the client. Trauma-focused therapy might not be appropriate for outdoor settings, but CBT for depression and anxiety may actually be more effective outdoors.
  • Develop a strategy for guaranteeing there will be shade and comfortable seating available.
  • Watch out for hazards in the area that could put you and the client in harms way (e.g., construction, traffic, animals, etc.)
  • It may be easier to lose track of time when conducting a session outdoors. Have a way to ensure the session does not go over time.
  • Access training to help you learn about the differences in providing counseling outdoors versus inside an office or via telehealth.
  • Update your informed consent forms to include outdoor therapy issues.
  • Confirm that your professional liability insurance cover sessions conducted outside your office.
  • Create a pandemic safety kit you can carry with you that includes face masks, hand sanitizer and gloves.  Your own personal safety is important too!



After considering the issues above, conducting outdoor sessions might be a good option for you.  These scenarios are obviously not meant to apply to every practitioner and not every client, but for therapists who are looking for outside-the-box ideas to continue providing services in the midst of a pandemic, these ideas may help.

Additionally, we need to put a waiver in here at the end.  Given how quickly things are changing, please verify for yourself the information we’ve provided is still accurate.  Whole programs can change within a week’s time.

Nevertheless, we are always happy to chat with you about your billing challenges.  If you have a question, comment or concern, we want to hear from you.  Send us an email or give us a call, and we’ll do our best to help.


General News Articles

Using Nature as a Therapeutic Partner
by Lyndsey Phillips – Counseling Today (April 26, 2018)


Why some practitioners of walk-and-talk therapy think it is especially helpful for teens
By Carolee Belkin Walker – The Washington Post (May 29, 2019) 


Other Practices Utilizing Outdoor Counseling

Into the Woods Counseling

Walk & Talk Counseling



Berger, Ronen (2008).  Building a Home in Nature: An Innovative Framework for Practice. Journal of Humanistic Psychology, 2008 (pp. 264-279).

Chalquist, C. (2009). A look at the ecotherapy research evidence. Ecopsychology, 1(2), 64-74.

Cooley, S. J., Jones, C. R., Kurtz, A., & Robertson, N. (2020). ‘Into the Wild’: A meta-synthesis of talking therapy in natural outdoor spaces. Clinical Psychology Review, 101841.

Hasbach, P. H. (2019). Ecopsychology Voices Interview with Dr. Patricia Hasbach.

Kahn, P. H., Jr., & Hasbach, P. H. (2012). (Eds.). Ecopsychology: Science, Totems, and the Technological Species. Cambridge, MA: MIT Press.

Jordan, M., & Hinds, J. (2016). Ecotherapy: Theory, research and practice. Macmillan International Higher Education.