Wiki is modifier 95 applicable for CPT code 96041?

[ShobihaaS]

As far as I can remember, we used to apply modifier 95 for CPT code 96040. With the recent changes in CPT guidelines, do we now need to use modifier 95 for CPT code 96041 as well?

 

[jkyles]

Hi there, if you check Appendixes P & T in your CPT manual you'll see it can be reported as an audio/video service (modifier 95) or an audio-only service (modifier 93). But of course, individual payers may have their own requirements

 

[ShobihaaS]

Alright for BCBSFL we are getting a rejection when updating with modifier 95. Ill try to locate specific guidelines based on payer.

 

[tiff.melone@gmail.com]

You can always check codify to see if a code is telemed-eligible, or your code book will also have a star next to it. other options for telemed rejections - policy does not cover telemed for that CPT code, POS does not apply to telemed services (11 intead of 02/10), payer might require GT instead (some Cigna payers do this, but not usually BCBS), see if the payer requires a separate telemed contract amendment. I hope you figured it out already and that this helps if you didn't!

 

[tiff.melone@gmail.com]

View attachment 7985 You can always check codify to see if a code is telemed-eligible, or your code book will also have a star next to it. other options for telemed rejections - policy does not cover telemed for that CPT code, POS does not apply to telemed services (11 intead of 02/10), payer might require GT instead (some Cigna payers do this, but not usually BCBS), see if the payer requires a separate telemed contract amendment. I hope you figured it out already and that this helps if you didn't!

It might also be the diagnosis - check out the CARC/RARC codes