Wiki Telehealth visits and modifier for 2025

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kkiger123

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Hello all, for the new CPT codes for audio only telehealth visits using POS 10, do we need to use modifier 93? Do we also use modifier 93 for straight Medicare telehealth visits as well?​

 
kkiger123 said:

​

Hello all, for the new CPT codes for audio only telehealth visits using POS 10, do we need to use modifier 93? Do we also use modifier 93 for straight Medicare telehealth visits as well?​

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Looks like Medicare will not be covering the new Telehealth code. This what I found
"The bad news is that Medicare does not plan to recognize the other 16 new telehealth codes (98000-98016) that CPT 2025 added. CMS plans to assign payment status code “I” (Not valid for Medicare purposes) to these codes. Therefore, for evaluation and management (E/M) visits performed over telehealth, you’ll continue to use the existing E/M codes, such as 99202-99215 for Medicare payers. It’s unclear which private payers – if any – do plan to recognize 98000-98016 in 2025. Most insurers will be issuing their 2025 coverage guidelines in the coming weeks." https://www.medcentral.com/coding-r...dule-targets-telehealth-advanced-primary-care
 
Hello,
Thank you for the update on the new telehealth codes, I understand that Medicare might not recognize them, but
what would have been the benefit of the new tele-health codes when practitioners can still submit a e/m visit using telehealth with the codes: 99202-99205 and 99211-99215?
 
rsinoben said:
I am now being told that Medicare will cover telehealth until March 2025. However the audio only codes are being discontinued and the new codes aren't recognized, so how will we bill Medicare for audio only?
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Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier 93
 
On the CMS website, they say "Absent Congressional action, beginning January 1, 2025, the statutory limitations thet were in place for Medicare telehealthservices prior to the Covid-19 PHEwill retake effectfor most telehealth services. These include geographic and location restrictions on where the services are provided, and limitations on the scope of practioners who can provide Medicare telehealth services."
Does that mean our doctors will not be able to do telemedicine E/M visits anymore since we are not in a rural area? We are a pulmonary practice and have a lot of elderly patients who prefer to do telemedicine visits. Any help will be much appreciated. Thank you.
 
mbanerjee said:
On the CMS website, they say "Absent Congressional action, beginning January 1, 2025, the statutory limitations thet were in place for Medicare telehealthservices prior to the Covid-19 PHEwill retake effectfor most telehealth services. These include geographic and location restrictions on where the services are provided, and limitations on the scope of practioners who can provide Medicare telehealth services."
Does that mean our doctors will not be able to do telemedicine E/M visits anymore since we are not in a rural area? We are a pulmonary practice and have a lot of elderly patients who prefer to do telemedicine visits. Any help will be much appreciated. Thank you.
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There was Congressional action. However, at the present time it simply extends coverage until 03/31/2025. I expect it will be extended past that (hopefully on a permanent basis), but only Congress may do so.
 
TThivierge said:
Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier 93
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The CPT book Appendix T for Audio Only codes does not list the E/M codes 99202-99205, 99211-99215, so I'm not sure if Medicare will accept the Modifier 93.
 
I work for a company that supports mental health members, and they are extending telehealth for Mental Health and I'm wondering why Medicare will not open up the new Telehealth codes for our members. The challenge we are coming across is that AHCCCS Medicaid is going to accept those new telehealth codes and Medicare is not, so that makes it difficult trying to communicate/train our providers to use two different types of codes.
 
forehandl said:
I work for a company that supports mental health members, and they are extending telehealth for Mental Health and I'm wondering why Medicare will not open up the new Telehealth codes for our members. The challenge we are coming across is that AHCCCS Medicaid is going to accept those new telehealth codes and Medicare is not, so that makes it difficult trying to communicate/train our providers to use two different types of codes.
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Forehandl
I heard will keep all telehealth CPT codes till Mar 2025. But also heard telehealth works best for mental health support. We use modifiers 93 and 95 with all Evt Mgnt codes but in the southern part of US. I hope this helps you. Also told to use modifier AI, AH and AJ when certain professionals do the session related to telelhealth.
Lady T
 
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rsinoben said:
I am now being told that Medicare will cover telehealth until March 2025. However the audio only codes are being discontinued and the new codes aren't recognized, so how will we bill Medicare for audio only?
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I'm wondering the same thing. First Coast doesn't have modifier 93 on their website, Novitas does, but it says:
This modifier should only be used by Opioid Treatment Programs (OTPs) and Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs):
Opioid Treatment Programs (OTPs) report on claims for counseling and therapy provided using audio-only technology.
Reference Opioid Treatment Programs Claims
RHCs and FQHCs report modifier on claims for mental health visits for audio-only technology.

UHC Medicare usually follows Medicare guidelines but they are not approving modifier 93 for use with codes not found in appendix t. So is audio only no longer covered in 2025?
 
TThivierge said:
Add the modifier 93 if phone call to Evt mgt CPT codes. Ensure provider list mode of treatment (phone call vs face to face).Naturally if face to face do not add modifier
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Can you confirm if CMS is covering AUDIO only for ALL conditions, or just ESRD and Mental health? I cannot find clear documentation either way. I understand that we are not to use the new CPT codes (98008-98015) and we are to use modifier 93 with POS 10 when patient is at home, but am unclear about the conditions being treated. Appreciate any guidance!
 
forehandl said:
I work for a company that supports mental health members, and they are extending telehealth for Mental Health and I'm wondering why Medicare will not open up the new Telehealth codes for our members. The challenge we are coming across is that AHCCCS Medicaid is going to accept those new telehealth codes and Medicare is not, so that makes it difficult trying to communicate/train our providers to use two different types of codes.
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I also am not sure what to do in our cases for Mental health for our Psychiatry practice which use medication management and psychotherapy. In 2024 we would code 99214-95, 90833-95, but the new 98006 code doesn't work with 90833, so insteadIi think we need to code with the 25 modifier on the telemedicine code, but it doesn't seem right? (98006-25, 90833-95)?
 
Has any one had success yet with the new telehealth code sets being accepted/paid? I am tracking all our claims going out the door with these codes, and so far NO ONE is paying. I have rejections from straight BCBS, UHC, Humana. I have tried the new codes utilizing POS 11, 10, 2. None of which have had any success. I had a feeling this was going to be a headache. When 99418 was introduced as the new prolonged visit code for inpatient visits, it took an entire month before all insurances had it implemented on their end and started paying. thank you in advance.
 
nwneurocoding said:
Has any one had success yet with the new telehealth code sets being accepted/paid? I am tracking all our claims going out the door with these codes, and so far NO ONE is paying. I have rejections from straight BCBS, UHC, Humana. I have tried the new codes utilizing POS 11, 10, 2. None of which have had any success. I had a feeling this was going to be a headache. When 99418 was introduced as the new prolonged visit code for inpatient visits, it took an entire month before all insurances had it implemented on their end and started paying. thank you in advance.
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I am also receiving rejections from UHC and BCBS with no change when POS codes changed.
UHC states "Report the status A (active) code that best describes the services provided. This claim has been rejected and will not be processed."

Interested to see if anyone else has had success?
 
This is what I have so far...

Aetna - Follow Medicare (per their risk adjustment inquiry team– no updated policy of their own yet)
BCBS - Follow Medicare (may want to check on this later to see if they update)
Cigna - Yes to new codes (per rep)/Policy will update at end of Jan (may want to wait until then to use the new codes)
Freedom/Optimum - Likely not, call member services: 800-401-2740
UHC/UMR/Wellmed - Following Medicare
 
As far as audio-only, per Dr. Lin he was providing conservative advice. HOWEVER, I think based on what I've found, we are safe to use audio-only through March as it stands.
All payers seem to want to make it a guessing game. But I'm trying to navigate it anyway, so this is my takeaway when it comes to Medicare and audio-only:
MLN901705 from April 2024 cites the Consolidated Appropriations Act, which states that audio only is allowed: "For most non-behavioral or mental telehealth, you must use 2-way, interactive, audio-video technology. Section 4113 of the Consolidated Appropriations Act, 2023 allows you to use audio-only telehealth for some non-behavioral or mental telehealth through December 31, 2024."
The flexibilities in this Act were then extended to March 2025 and the most recent MLN (MM13887) seems to confirm this when it states "We’re also finalizing: Starting January 1, 2025, an interactive telecommunications system may include two-way, real-time, audio-only communication technology for ANY telehealth service provided to a patient in their home if the distant site provider is technically capable of using an audio-video telehealth system, but the patient isn’t capable of, or doesn’t consent to, using video technology."
I also reached out to their inquiry team to confirm again what services may be provided via audio-only and this was their response. "For CY 2025, we are not specifying specific codes that can be furnished audio-only. While practitioners should always use their clinical judgment as to whether the use of interactive audio-only technology is sufficient to furnish a Medicare telehealth service, we recognize that there is variable broadband access in patients’ homes, and that even when technologically feasible, patients simply may not always wish to engage with their practitioner in their home using interactive audio and video." Vague, of course, but a response nonetheless with no mention of audio-only being restricted to behavioral/mental health. Looks to me like audio-only continues to be allowed like last year, at least until March for now.
 
Hi some one give suggestion wheather still we can use 95 modifier for cpt 98000-98007 still allowed to but portals and codify ? not showing any edits kindly navigate me how to use 95 modifer
 
gebbs.98@gebbs.com said:
Hi some one give suggestion wheather still we can use 95 modifier for cpt 98000-98007 still allowed to but portals and codify ? not showing any edits kindly navigate me how to use 95 modifer
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BCBS ND gives clear direction on codes that do not require 95 modifiers, and the 98XXX codes are on that list. So they are not required. But the 9921X codes would need the modifier.
 
marisaheller5 said:
Hello,
Thank you for the update on the new telehealth codes, I understand that Medicare might not recognize them, but
what would have been the benefit of the new tele-health codes when practitioners can still submit a e/m visit using telehealth with the codes: 99202-99205 and 99211-99215?
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Any thoughts on this? I'm wondering the same thing.
 
coderfromtexas said:
Any thoughts on this? I'm wondering the same thing.
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CPT codes are created by the AMA after their committees and research decided new codes were needed. AMA does not decide any payor policies.
CMS took the stance that the existing CPTs 99202-99215 already accurately reflect the services (with modifier added) which is why Medicare will not recognize the new codes.
Commercial payors are each making their own decision whether to accept the new codes, or follow Medicare policy. From what I have seen, they are overwhelmingly going with Medicare policy.
 
juliedogra86 said:
I also am not sure what to do in our cases for Mental health for our Psychiatry practice which use medication management and psychotherapy. In 2024 we would code 99214-95, 90833-95, but the new 98006 code doesn't work with 90833, so insteadIi think we need to code with the 25 modifier on the telemedicine code, but it doesn't seem right? (98006-25, 90833-95)?
Click to expand...
I was wondering the same thing. I work for a psychiatry practice that regularly bills EM+psychotherapy add on codes. Have you confirmed that you can't bill the add on with the new codes? Any luck with the -25 mod?
 
Is anyone still using the audio only 99441-99443 and are you getting paid? Or are you using the telehealth 98008-98015 or are you using E/Ms with modifier 93 and POS02/10?
 
1) 99441-99443. I am not aware of any carrier recognizing these in 2025, as they have been officially deleted 12/31/2024
2) 98008-98015. I am not aware of any carrier recognizing these that does not also accept 99202-99215 with mod 93. Could be out there, but I'm not aware of any.
As a result of the above, we are coding our audio only as 99202-99215 with modifier 93 and POS 02/10 (in fact, exclusively 10 for my specific practices). There have been occasional denials (just like for any codes), but the overwhelming majority are being paid first process.
 
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