Oncology & Hematology Coding Alert

Question: I am still very confused about the correct modifiers to use for telehealth visits once the public health emergency (PHE) flexibilities end. In particular, I am confused on when to use 02 versus 11. I have heard 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. What constitutes “that would have been used if the patient was seen in person rather than POS 02 telehealth?”

Also, just for confirmation, 93 is for audio only but do we continue using 95 for audio/visual?

AAPC Forum Participant

Answer: While the PHE ended on May 11, 2023, many of the flexibilities put into place will continue for the remainder of 2023 and some even throughout 2024. Medicare has indicated they will continue to reimburse encounters at the POS it would have been furnished in-person at least until the end of 2023. For example, if a visit conducted via telehealth would have occurred in the office had it been in-person, then POS 11 (Office) would be appropriate.

Medicare also requires modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) or 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system), depending on whether the service is audio only (93) or audio/video (95), as you say.

Commercial carriers have varying preferences for reporting telehealth services as some may prefer POS 02 (Telehealth provided other than in patient’s home) with or without a modifier.

The bottom line: Always check carrier policies, which can vary from state to state, when billing telehealth services.