What is the modifier 93 for telehealth?
Asked by: Prof. Candace Wuckert I | Last update: October 13, 2025Score: 4.1/5 (71 votes)
What modifier is used for telehealth?
The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Does Medicare accept modifier 93 in 2024?
Now, in a recent Medicare Change Order, Medicare is changing their mind, saying they DO want these modifiers in all telehealth billing. According to the Change Order, Place of Service codes now “must be paired with the appropriate telehealth modifier (modifier 93 for audio-only and modifier 95 for audio/video).”
How to bill for telehealth for behavioral health?
- 98000-98003: New client audio-video telemedicine visits.
- 98004-98007: Established client audio-video telemedicine visits.
- 98008-98011: New client audio-only telemedicine visits.
- 98012-98015: Established client audio-only telemedicine visits.
What is the modifier for UHC telehealth?
UnitedHealthcare Community Plan requires one of the telehealth-associated modifiers (GT, GQ, G0 or 95) to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth.
Telehealth Modifiers You Might Not be Aware of FR, FQ, 93, and XE & 59, and are Audio Sessions Ok?
When to use modifier 93?
-93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.
Does UHC accept modifier 93?
UnitedHealthcare aligns with the AMA and will consider for reimbursement the services included in Appendix T of the CPT code set, which are appropriate for reporting real-time, interactive audio-only Telehealth, when appended with modifier 93, and reported with POS 02 or 10.
What is the 95 modifier for behavioral health?
Mental health modifier 95, designated as “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system,” serves as a flag to insurance carriers, indicating that a mental health service was provided remotely using real-time audio and video technology.
What is the difference between telehealth and telemedicine?
While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. There are several other ways to define telehealth.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
When did modifier 93 go into effect?
Modifier 93 is a new audio-only telemedicine code that went into effect on Jan. 1, 2022. Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications system.
How to code a telehealth visit?
- 99202-99205: Office/outpatient E/M visit, new patient.
- 99211-99215: Office/outpatient E/M visit, established patient.
- G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
Will Medicare stop paying for telehealth in 2025?
Telehealth policies allow: Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through March 31, 2025. There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through March 31, 2025.
How to bill telehealth in 2024?
Coding for Audio-video Visits
Use the POS that aligns with the patient's location. As of January 1, 2024, Medicare pays telehealth services provided in the patient's home (POS 10) at the non-facility rate. Telehealth services provided at an originating site (POS 02) are paid at the facility rate.
Do you use 95 or GT modifier for telehealth 2024?
For institutional billing, use modifier 95 for dates of service on and after January 1, 2024, through December 31, 2024, when: The clinician is in the hospital and the patient is in their home. Outpatient therapy provided via telehealth by PTs, OTs or SLPs employed by hospitals.
What modifier does Aetna use for telemedicine?
Modifiers GT, 95, FR
When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. Click herefor more information about our telemedicine liberalization in response to the Coronavirus COVID-19 outbreak.
What are the three types of telehealth?
There are three main types of telemedicine, which include store-and-forward, remote monitoring, and real-time interactive services. Each of these has a beneficial role to play in overall health care and, when utilized properly, can offer tangible benefits for both healthcare workers and patients.
Is telehealth considered medical treatment?
Telehealth (previously called telemedicine) is seen as a tool in medical practice, not a separate form of medicine. There are no legal prohibitions to using technology in the practice of medicine, as long as the practice is done by a California licensed physician and complies with state and federal privacy laws.
What is the difference between virtual healthcare and telehealth?
Virtual care includes not only telehealth services but also other forms of digital healthcare, such as online appointments, remote patient monitoring, and virtual visits with doctors or other healthcare providers. Virtual health encompasses all things in Telehealth and Digital Health.
What is mod 93?
Modifier 93 descriptor
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 site from the physician or other qualified health care professional.
What is modifier 96 used for?
A provider appends this modifier to habilitative services. The provider delivers habilitative services to develop, maintain, or improve a patient's skills to perform his activities of daily living (ADLs) or instrumental activities of daily living (IADLs).
What is modifier 33 for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
What is the modifier code for telehealth?
CPT Telemedicine Codes
Modifier 95 indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.
How long will telehealth be covered by insurance in 2024?
Unlike the DEA flexibilities, many of the COVID-era flexibilities for traditional Medicare coverage of telehealth services will end on December 31, 2024. Despite bipartisan support, congressional action is required to extend broad coverage for certain telehealth services existing since March 2020.
What is the modifier for telehealth in UnitedHealthcare?
UnitedHealthcare requires one of the telehealth-associated modifiers (GT, GQ, G0 or 95) to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth.