Wiki Medicaid Plans and Audio only Telehealth

[kprevete@parkmedicalcenters.com]

Does anyone have any luck billing medicaid plans for audio only. Per Medicaid guidelines, we're supposed to bill E/M codes with 93 modifier as they don't recognize the new 2025 telehealth codes yet. I'm receiving denials from these plans as invalid modifier, if 9944 codes are deleted what is to be billed

 

[sjadoul]

Does anyone have any luck billing medicaid plans for audio only. Per Medicaid guidelines, we're supposed to bill E/M codes with 93 modifier as they don't recognize the new 2025 telehealth codes yet. I'm receiving denials from these plans as invalid modifier, if 9944 codes are deleted what is to be billed

I have not had any luck coding ANY audio-only phone consults for commercial insurance or otherwise. The new codes don't work and appending modifier -93 to the E/M code does not work either. I just think audio-only coverage has expired with Medicare declaring it and no insurances will cover unless mental health. All claims have been denials for audio-only with old codes and E/M codes -93 (the procedure code is inconsistent with the modifier used or a required modifier is missing). Same exact denial for new audio-only codes as well. I just think they are no longer a covered benefit.

 

[cbreeze@horizon-health.org]

I have not had any luck coding ANY audio-only phone consults for commercial insurance or otherwise. The new codes don't work and appending modifier -93 to the E/M code does not work either. I just think audio-only coverage has expired with Medicare declaring it and no insurances will cover unless mental health. All claims have been denials for audio-only with old codes and E/M codes -93 (the procedure code is inconsistent with the modifier used or a required modifier is missing). Same exact denial for new audio-only codes as well. I just think they are no longer a covered benefit.

Even in Mental Health E&Ms are used for medication management, does the 2025 final rule mean only the therapy services are allowed audio only and not the psychiatry services? Only the therapy and evaluation codes are continued under the final rule. I am not seeing anything for prescription follow up/management for our providers.