Neurology & Pain Management Coding Alert

Question: I heard there was a new telehealth modifier that we’re supposed to be using now. Is this correct?

Montana Subscriber

Answer: Yes, there is a new telehealth modifier whose effective date was Jan. 1, 2021. Modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) won’t be on the books until 2023, but CPT® wants you to use it this year.

“The following modifier was accepted at the September 2021 CPT^® Editorial Panel meeting for the 2022 CPT^® production cycle,” according to the AMA.

More info: “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,” the AMA reports.

Also, remember that the communication must be between a physician or other qualified healthcare professional and the patient, and “the totality of the communication … must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.”

Check out the release at https://www.ama-assn.org/system/files/cpt-appendix-a-modifier-93.pdf.