Wiki Modifier 95 in 2024

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HerMDInc

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Good morning Community!
I need your help and expertise... as I understand it, CMS has stated that a -95 modifier is no longer necessary and that POS (10/2) will be dictate the telehealth visit going forward. I am not confident all of the commercial payors will adjudicate telehealth claims without the modifier. Our new EHR will no longer offer the 95 modifier based on CMS guidelines, which has our clinical team reworking ops that will include extra steps the provider will have to take to append the modifier. All of us know we need to make it easy for our providers to maximize claim reimbursment! I would very much like to hear what you are experiencing and if you are still using the -95 modifier for telehealth services. Look forward to y'alls thoughts! Thanks
 
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Hi
If the clinician is a MD,DO, NP or PA licensed for phone calls can use CPT 99442-99446 no modifier. If the clinician is R.Nurse, LPC ,LCSW or QHP can use CPT 98966-98968. Ensure add minutes in the record for the day spoke with patient plus define mode of treatment ( phone call or video).I hope this data will help you
Lady T
 
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There is extensive information about this online via google. You have to check the individual payer policy for their telehealth/virtual policy and what modifiers they may or may not want.

Example from UHC link above: "Modifiers 95, GT, GQ and G0 are not required to identify Telehealth services but are accepted as informational if reported on claims with eligible Telehealth services"
 
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amyjph said:
There is extensive information about this online via google. You have to check the individual payer policy for their telehealth/virtual policy and what modifiers they may or may not want.

Example from UHC link above: "Modifiers 95, GT, GQ and G0 are not required to identify Telehealth services but are accepted as informational if reported on claims with eligible Telehealth services"
Click to expand...
Thank you so much for your response! I have dug into the provided links but am still at a loss as to which commercial payors may still require the -95 modifier for Telehealth visits. I appreciate the UHC callout as I see they do not require but will accept if appended. Does your practice currently provide telehealth services and if so are you appending the TH modifier? I am really looking for the top payors Anthem, BCBS, Aetna, Cigna and Humana. Any additional insights are appreciated. Thank you again!
 
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TThivierge said:
Hi
If the clinician is a MD,DO, NP or PA licensed for phone calls can use CPT 99442-99446 no modifier. If the clinician is R.Nurse, LPC ,LCSW or QHP can use CPT 98966-98968. Ensure add minutes in the record for the day spoke with patient plus define mode of treatment ( phone call or video).I hope this data will help you
Lady T
Click to expand...
Thank you for your time and response! I am still at a loss as it relates to if commercial payors are still requiring the 95 modifier for telehealth services. Currently our practice does not provide phone assessments or follow ups only telehealth via video calls. With the CMS new guidelines our current PM system no longer provides the modifier in the system but I have read many online articles that say check with the payor directly and I am trying to find the easiest way to gather this info quickly from the commercial payors directly. Any additional insights are greatly appreciated. Many thanks!
 
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HerMDInc said:
Thank you for your time and response! I am still at a loss as it relates to if commercial payors are still requiring the 95 modifier for telehealth services. Currently our practice does not provide phone assessments or follow ups only telehealth via video calls. With the CMS new guidelines our current PM system no longer provides the modifier in the system but I have read many online articles that say check with the payor directly and I am trying to find the easiest way to gather this info quickly from the commercial payors directly. Any additional insights are greatly appreciated. Many thanks!
Click to expand...
Use of modifiers 95 (video) or 93 (phone)can be added on other Eval Mgmt. CPT codes. Verify with your payor but check in CPT manual tell you which CPT can use modifiers 93 or 95 too in Appendix T and P. I hope helped you
Lady T
 
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HerMDInc said:
Good morning Community!
I need your help and expertise... as I understand it, CMS has stated that a -95 modifier is no longer necessary and that POS (10/2) will be dictate the telehealth visit going forward. I am not confident all of the commercial payors will adjudicate telehealth claims without the modifier. Our new EHR will no longer offer the 95 modifier based on CMS guidelines, which has our clinical team reworking ops that will include extra steps the provider will have to take to append the modifier. All of us know we need to make it easy for our providers to maximize claim reimbursment! I would very much like to hear what you are experiencing and if you are still using the -95 modifier for telehealth services. Look forward to y'alls thoughts! Thanks
Click to expand...
Look in back of the CPT manual Appendixes T and P give you a list of CPT codes can add modifiers 93 or 95. I hope this helps you.
 
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You have to check the individual payer policy for their telehealth/virtual policy and what modifiers they may or may not want.
Usually they are named sush as: Telehealth/Virtual Health Policy, Modifier 95 Policy, Telehealth, etc.

Here is an example from UHC Community Plan: https://www.uhcprovider.com/content...th-Policy-Professional-and-Facility-R7133.pdf starting on pg. 9 there are state resources and other resource info with links.

Some of the specialty societies have charts, however you would still want to double check with the payer to make sure it is correct.
Example: https://www.aafp.org/family-physici...-telehealth-audio-virtual-digital-visits.html
 
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