Wiki Help with Telehealth visits and modifiers 02, 10, 11.

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Brandy0618

Brandy0618

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Good day. I am requesting clarification to the end to PHE where modifiers 02, 10, and 11 are concerned. I am so confused. What does it mean when it is described as "Medicare has told practitioners to use the place of service (POS) that would have been used if the patient was seen in person rather than POS 02 telehealth"? I am confused on when to use 02, vs 11? What constitutes "that would have been used if the patient was seen in person rather than POS 02 telehealth"? I do not know when to apply 02 vs 11 when reporting telehealth? I know this ends on 12-31-23.
I read an article from CodingIntel that states "Don't use 02 or 10 of you would have used POS 11 for the office service." If a patient completes a telehealth appointment at their office would we append modifier 02? If in their home, 10?
Just for confirmation, 93 is for audio only but we continue using 95 for audio/visual? I appreciate any information that can help clarify this for me.

Thank you so much! :)
 
So, like tjuntunen1 said, every insurance has their own rules. I can only speak to a specialist office setting but I'm sure it would apply to a PCP office as well. In Virginia, UHC wants POS 02 with no modifier. Cigna Commercial, Anthem (commercial and HK+) and Aetna Commercial requires POS 02 with a 95 mod (93 if telephone visit). All other commercial payers require POS 11 with a 95 mod (93 if telephone visit). All Medicare products require POS 11 with a 95 mod (93 if telephone visit). I might have missed some insurances but these are the ones I encounter almost every day. And, of course, they are all subject to change at the whim of the insurance companies. I don't know if the commercial plans vary from state-to-state regarding requirements or not but I wouldn't think they would.
 
@jtimothy We are in NC, I have coworker who is trying to bill audio only visit for Medicare, and she states they rejected the 93 modifier. Is FQ modifier correct for audio only?
 
I've never used 93 modifier for any payers. I live in Texas and do billing for doctors in Connecticut so every insurance is different and it's a lot to remember. In my experience, Medicare requires audio-video for office visit (99201-99215) telehealth services with 95 modifier. Audio only (for Medicare) are typically billed using the appropriate telephone e/m codes (99441-99443) with 95 modifier.

Hope that helps : )
 
mfm1988 said:
@jtimothy We are in NC, I have coworker who is trying to bill audio only visit for Medicare, and she states they rejected the 93 modifier. Is FQ modifier correct for audio only?
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I haven't seen a rejection yet from using the 93 modifier here in Virginia with Medicare or any other insurance. Our providers don't do too many telephone only visits anymore, though, as a lot of commercial payers will not cover them. The 93 modifier is fairly new as we were using 95 for all telemedicine visits for most of the pandemic. It seems a bit redundant to me, though, since 99441-99443 specifies a telephone only visit but what can you do? :) I did find this on another thread here:

"Additionally, effective on and after January 1, 2023, CPT modifier “93” can be appended to claim lines, as appropriate, for services furnished using audio-only communications technology in accordance with our regulation at § 410.78(a)(3). All providers, including RHCs, FQHCs, and OTPs must append Medicare modifier “FQ” (Medicare telehealth service was furnished using audio-only communication technology) for allowable audio-only services furnished in those settings. However, consistent with our proposal for audio-only services furnished under the PFS, we are also finalizing to require all providers including RHCs, FQHCs, and OTPs to use modifier “93” when billing for eligible mental health services furnished via audio-only telecommunications technology. Providers have the option to use the “FQ” or the 93” modifiers or both where appropriate and true, since they are identical in meaning."

Hope that helps some.
 
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