What Is Modifier 93 Used For in Telehealth Billing?
Navigate telehealth billing complexities. Discover how Modifier 93 ensures accurate coding for synchronous virtual care, optimizing reimbursement and compliance.
Medical coding modifiers are two-character codes appended to Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes. These modifiers provide additional context and specificity about a medical service or procedure without altering the main code’s definition. They are essential for accurate reporting of services, ensuring proper reimbursement and efficient claim processing.
Purpose of Modifier 93
Modifier 93 is specifically used in telehealth billing to identify a “synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.” Its primary purpose is to distinguish audio-only telehealth encounters from those that utilize both audio and video, which are typically reported with Modifier 95.
Application Guidelines for Modifier 93
Modifier 93 requires the telehealth service to be delivered through a synchronous, real-time interactive audio-only telecommunications system, with both the healthcare professional and the patient present and interacting in real-time. This modifier is distinct from services involving both audio and video, or asynchronous “store-and-forward” services. Modifier 93 specifically applies when only audio communication is used, while Modifier 95 is for real-time audio-visual visits.
Many CPT codes that can be performed via audio-only communication are listed in Appendix T of the CPT book. Behavioral health services, such as psychiatric diagnostic evaluations, are examples of services where audio-only interaction can meet the requirements, and Medicare has permanently allowed audio-only for mental health services delivered to patients in their homes. When using Modifier 93, the communication must be sufficient to meet the key components and requirements of a comparable face-to-face service. Documentation in the patient’s medical record should indicate the reason for audio-only delivery, such as the patient’s preference or lack of technical capacity for video. Obtaining and documenting patient consent for the audio-only encounter is also a requirement.
Reimbursement and Compliance Considerations
The use of Modifier 93 has direct implications for reimbursement, as payer policies for telehealth services can vary significantly. Providers must stay informed about specific payer guidelines, as these can impact whether a service is covered and at what rate. For services furnished to Medicare beneficiaries, Modifier 93 signals that the service was provided via audio-only, and services delivered in the patient’s home (Place of Service 10) are reimbursed at a non-facility rate. Audio-only medical services (excluding behavioral health) are temporarily permitted through September 30, 2025, if the patient is in their home and unable or unwilling to use video.
Accurate application of Modifier 93 is essential for demonstrating compliance with telehealth service requirements, especially during audits. Incorrect or omitted modifiers can lead to claim denials, delays in payment, and potential financial penalties. Misusing modifiers can result in significant fines. Understanding and correctly applying Modifier 93 is fundamental for healthcare providers to ensure proper reimbursement and avoid compliance issues in telehealth billing.