What is the CMS modifier 93 for telehealth?
Asked by: Carissa Moen | Last update: January 24, 2024Score: 4.6/5 (28 votes)
Modifier -93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System: Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant ...
What is the modifier 93 for telehealth?
Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications system. Use of this modifier is appropriate only if the real-time interaction occurs between a physician/other qualified health care professional and a patient who is located at a distant site.
What is the 93 modifier for CMS 2023?
CMS also states that beginning January 1, 2023, CPT modifier “93” must be used for eligible mental health services provided using audio-only technology. All providers must also append Medicare modifier “FQ” for allowable audio-only Medicare telehealth services.
What is the CMS audio only modifier 93?
The American Medical Association (AMA) has released new CPT code modifier 93 for audio-only telehealth services. The AMA approved the modifier at the September 2021 CPT editorial meeting; AMA made it available on their website on December 30, 2021. The code became effective two days later on January 1, 2022.
What is the modifier for telehealth services?
What is GT Modifier? GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means “via interactive audio and video telecommunications systems.” You can append GT to any CPT code for services that were provided via telemedicine.
Modifier 93 audio only modifier in telehealth coding & Appendix T
What is the 93 modifier used for?
Modifier -93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System: Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant ...
Do you use 95 or GT modifier for telehealth?
The GT modifier is a coding modifier that is most commonly used for telehealth claims. According to the AMA, the modifier means “via interactive audio and video telecommunications systems.
What is the difference between modifier 93 and modifier FQ?
Modifier 93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system. Modifier FQ: Service was furnished using audio-only communication technology.
What is the modifier for audio only telehealth 2023?
Telephone (audio only) Evaluation and Management (E&M) codes must include modifier 93.
What is the code for telemedicine audio?
- 99441: telephone E/M service; 5-10 minutes of medical discussion.
- 99442: telephone E/M service; 11-20 minutes of medical discussion.
- 99443: telephone E/M service, 21-30 minutes of medical discussion.
What is the CMS modifier for telehealth in 2023?
For 2023, you should continue billing telehealth claims with the place of service indicator you would bill for an in-person visit. You must use modifier 95 to identify them as telehealth services through the end of CY 2023 or the end of the year in which the PHE ends.
What is the CMS rule 2023?
On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings ...
What are the new Medicare billing rules for 2023?
When Congress passed its year-end omnibus legislation in the final days of 2022, it included a 2% Medicare physician payment cut for 2023. As a result, the Centers for Medicare and Medicare Services (CMS) updated the 2023 conversion factor to $33.8872 for 2023.
What is the CMS modifier for audio only?
New modifier for reporting audio-only services -- FQ modifier. CMS allows some services to be furnished as audio-only when the member does not have access to two-way audio-visual communication technology or did not consent to its use.
What is the modifier code for telehealth therapy?
CPT Code Modifier 95
This modifier's description is for “Synchronous Telemedicine Services Rendered via Real-Time Interactive Audio and Video Telecommunications Systems”.
What is the modifier for telehealth 90834?
Telehealth with modifiers and codes
In behavioral health, the modifier 95 is added to the original code to signify teletherapy. For example, you would add the 95 modifier to 90834 to signify a 45-minute teletherapy session (i.e., 90834-95).
Does Medicare cover audio only telehealth?
The audio-only services are reimbursed at the same rates as in person services. These waivers and flexibilities have facilitated the widespread use of telehealth and other communication-based technologies.
Can you use modifier 25 on a telehealth visit?
Telehealth E/M visits may result in the determination of the need for a COVID-19 specimen collection. Providers must submit modifier 25 and 95 on the Telehealth E/M to support the separately identifiable Telehealth visit from the onsite clinical staff collection fee.
What is the telehealth modifier for United?
Reimbursement: UnitedHealthcare Community Plan will reimburse telehealth services that are: Recognized by CMS and appended with modifiers GT or GQ. Recognized by the AMA, included in Appendix P of CPT and appended with modifier 95.
Will Medicare continue to pay for telehealth in 2023?
Medicare telehealth coverage
Medicare's coverage of telehealth for outpatient services will largely remain the same after the Consolidated Appropriations Act of 2023 (CAA) extended many telehealth flexibilities through the end of 2024.
What is the difference between synchronous and asynchronous telehealth?
Synchronous telehealth is a live, remote exchange of patient information through direct, real-time interaction between a physician and a patient. Asynchronous health is a “store-and-forward” approach where the patient shares info through a patient portal and the provider reviews it later.
What is Medicare Category 3 telehealth?
CMS' Category 3 list contains services that likely have a clinical benefit when furnished via telehealth, but lack sufficient evidence to justify permanent coverage.
What is the correct coding for telehealth visits?
Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes 99441-99443).
What is the Medicare POS and modifier for telehealth?
Place of Service codes
There are currently two POS codes: POS 02: Telehealth provided other than in patient's home. Patient is not located in their home when receiving health services or health related services through telecommunication technology. POS 10: Telehealth provided in patient's home.
What is the G code for telehealth services?
New G-Codes for Telehealth Services
The G0320 code is used for telehealth services that involve both audio and video components. For phone calls or audio-only services, use code G0321, and for remote patient monitoring, use code G0322.